8 P E RM AT ORRHCEA 



LIBRARY OF CONGRESS. 



UNITED STATES OF '.ERICA. 



SPERMATORRHEA: 

ITS CAUSES, 
SYMPTOMS, RESULTS AND TREATMENT, 

BY 

ROBERTS BARTHOLOW, A.M., M.D., 

Professor of the Theory and Practice of Medicine and of Clinical Medicine, in 

the Medical College of Ohio ; Physician to the Hospital 

of the Good Samaritan, etc., etc. 






FOURTH EDITION, REVISED. 



NEW YORK : 
WILLIAM WOOD & CO., 27 GREAT JONES ST. 

1879. 

ALL EIGHTS RESERVED. 



^ io...l 









Copyright 1879, 

By William Wood & Company, 

New York. 



New York : J. J. Little & Co., Printers, 
10 to 20 Astor Place. 



PREFACE TO THE FIRST EDITION. 



A short essay on the Pathology and Treatment 
of Spermatorrhoea, based upon a clinical lecture 
delivered at St. John's Hospital; and published in 
the Cincinnati Journal of Medicine, having met 
with a very favorable reception from the profession, 
it has seemed desirable to give the subject fuller 
treatment from the same point of view. 

There have been but few special treatises on this 
disease of a reputable character. Tbe work of 
Lallemand, Des pertes seminales involont aires, Paris 
et Montpellier, 1837-41, is the source from which 
subsequent writers have drawn their information. 
A portion of this w r ork has been presented in 
an English dress by two translators — Wood and 
McDongall. Additions to the translation of the 
last named have been made by Maris Wilson, and 
in this form it is the principal authority now in 
the hands of American physicians. The subject is 
also discussed, necessarily in an incomplete manner, 
in various works on the practice of medicine and 
surgery. Besides these authorities, Mr. Acton has 
lately addressed the general public in a work on 
the reproductive organs, in which he discourses 
more or less fully on Spermatorrhoea. 

iii 



I think it is a reproach to our profession that 
this subject has been permitted, in a measure by 
our own indifference, to pass into the hands of the 
unscrupulous pretenders, whose suggestive publi- 
cations are amongst the crying evils of our time. 
Because the subject is disagreeable, and to a certain 
degree disreputable, competent physicians are loath 
to be concerned with it. The same unnecessary 
fastidiousness causes the treatment of this malady 
to be avoided in private practice ; and the unfortu- 
nate patients, thus precluded from obtaining intel- 
ligent advice, fall into the hands of advertising 
specialists, who excite their worst apprehensions 
for a mercenary purpose. For this reason, and to 
obviate the sad consequences which result from 
spermatorrhoea, it is our duty to exert our best 
efforts in behalf of those afflicted with this malady. 
We should endeavor to attain to correct views of 
its pathology, and apply our knowledge to its cure 
— if for no other reason, for the good of our, species. 

My little work will have done all that I can de- 
sire for it, if it assist the practitioner in forming 
correct view 7 s of the nature of spermatorrhoea, and 
enable him to conduct cases of this disease to a 
more successful issue than he has hitherto been 
able to accomplish. 



PREFACE TO THE SECOND EDITION. 



A second edition of this monograph having been 
called for within less than a year after the publica- 
tion of the first, is a gratifying evidence of the appre- 
ciation of my labor by the medical profession. 

In the present edition, some typographical errors, 
overlooked in the first, have been corrected ; a table 
of contents has been appended, and new matter has 
been added at various places throughout the volume. 
These improvements will, I trust, make the present 
edition still more worthy of the favor so largely ac- 
corded to the first. 

v 



PREFACE TO THE THIRD EDITION. 



I have to express my acknowledgments to the 
medical profession for the very great favor with 
which the two previous editions of this work have 
been received. As it now appears in this edition, 
the material has been rearranged, and in large parfc 
rewritten. Some illustrations have been introduced, 
and an appendix of formulae added. The value of 
the book will, I trust, be considered to be enhanced 
by these changes and additions. 

More enlarged experience since the appearance of 
the first edition has not caused me to amend any of 
my views of the nature and true mode of treating 
spermatorrhoea. I am, indeed, more than ever con- 
firmed in the view that it is ^neurosis, and that the 
treatment, to be successful, must be founded on this 

pathological basis. 

E. B. 



PREFACE TO THE FOURTH EDITION. 



Ix the preface to the first edition of this mono- 
graph, I haye stated the accident, so to speak, to 
which it owes its origin. The hack article of the 
Journal has expanded into the present volume, by 
successive additions of material and by rewriting, 
until now it has but little similitude to its pro- 
genitor. The demand for new editions is a proof, 
that the monograph fills a place in medical litera- 
ture, although that place is, necessarily, an hum- 
ble one. The original purpose of the author has 
been maintained throughout — to place the subject 
on a scientific basis, and to divorce it from char- 
latanism. 

Doubtless the success of this work as a business 
venture would have been greater, if I had pan- 
dered to a vicious popular taste, and whilst giving 
it a quasi-scientific character, had really so writ- 
ten it as to place it on a level with the lay under- 
standing. 

Besides the public expressions of approval in the 
recognized organs of professional opinion, I have 

vii 



Vlll PREFACE. 

received many private assurances from my medical 
friends and correspondents, that my little work 
has accomplished good. This fact, alone, would 
have justified me in undertaking the labor of re- 
vision, so pressed am I on all sides by professional, 

professorial, and literary work. 

K. B. 



CONTENTS. 



Introduction 1 

I. True Spermatorrhea 5 

Causes 5 

Symptoms 29 

I. Genital Form 87 

II. Cerebral Form 44 

III. Spinal Form 50 

Results 56 

II. Sperm atorrhcea as a Symptom 65 

III. Imaginary Spermatorrhea 75 

IV. Treatment 78 

Formulae 124 



rx 



SPERMATORRHEA : 

ITS CAUSES, SYMPTOMS, EESULTS, AND 
TREATMENT. 



INTRODUCTION. 

It seems to be necessary to define, at the out- 
set, what is meant by Spermatorrhoea. The sense 
in which this term is used not always being the 
same, confusion has arisen as to its real patho- 
logical import. By some, following in a literal 
sense its etymological signification, this term is 
restricted to that condition in which there is a 
constant stillicidium of semen, without, of course, 
the preHminary phenomena of erection and ejac- 
ulation. If this definition be accepted, sper- 

1 



2 SPERMATORRHEA. 

matorrhcea can be admitted to exist but 
rarely. 

According to a more widely received view, 
spermatorrhoea consists in the emission of semen 
without copulation, or in involuntary seminal 
losses of every kind. If the former definition 
be defective by reason of too limited scope, the 
latter is defective in a more injurious degree, 
because it embraces a physiological as well as a 
pathological state. 

The term spermatorrhoea should be restricted 
to that condition in which involuntary seminal 
losses occur with sufficient frequency to produce 
a definite morbid state. 

It is very important to be accurate on this 
point, for nothing is more common than mistaken 
views in regard to the pathological importance of 
occasional spermal losses. A physiological con- 
dition is frequently confounded with the results 
of disease. The prevalence of this error is due 
chiefly to the false statements so persistently put 
forth by advertising specialists in regard to the 
evil consequences of nocturnal pollutions. I can- 
not too strongly impress on my readers, that after 
the period of puberty involuntary seminal losses 



NTKODUCTION. 6 

occur in the continent with more or less fre- 
quency, according to the activity of their sexual 
organs. The young man who, ignorant of its 
nature, happens to this accident for the first 
time, is much concerned, especially if he have 
read the impure publications on this topic now 
so widely distributed. In such a case the in- 
telligent and humane physician may render a 
lasting service by an exact statement of the 
importance of these physiological emissions. 

Although many cases of so-called spermator- 
rhoea are physiological in character, we should 
not therefore assume that no morbid state is 
produced by frequent involuntary losses. 

Spermatorrhoea is also a symptom of lesion 
of some part of the central nervous system. It 
has, then, but little importance as compared 
with the serious disease of which it is but an 
indication. 

It follows from the foregoing considerations, 
in order to have a true comprehension of sper- 
matorrhoea, it must be studied from several 
points of view. I purpose, therefore, to treat 
of the subject according to the following 
scheme : 



SPERMATORRHOEA. 

1. True Spermatorrhoea. 

Its Causes. 

Physical. 

Moral. 
Its Symptoms. 
Its Results. 

2. Spermatorrhoea as a Symptom. 

3. False or Imaginary Spermatorrhoea. 

4. Treatment. 



CAUSES. 5 

I. 

TRUE SPERMATORRHEA. 

CAUSES. 

Physical. — The vice of masturbation is un- 
doubtedly the chief cause. The growth of the 
sexual apparatus at the period of puberty is ac- 
companied by abundant secretion of the semi- 
nal fluid, which accumulates in the reservoirs. 
The sexual instinct, then fully developed, ex- 
erts a powerful influence over the mind, whilst 
the reason is not in a sufficiently matured state 
to correct the mirages of the imagination. ' An 
accidental friction of the erect organ in these 
moments of delirium makes the unfortunate 
youth acquainted with a new and voluptuous 
sensation.* Ignorant of the dreadful conse- 
quences which must ensue from the repeated 
perpetration of this act, the youth perseveres in 
his secret pleasures until arrested by realizing 
some of the sad effects upon the mind and body 
which follow. 

* Tissot. L'Onanisme. Dissertation sur Us Maladies pro- 
duites par la Masturbation. Also, Fournier et Begin, Die- 
tionnaire des Sciences Medicates, vol. xxxi., pp. 100-134. 



6 SPERMATORRHEA. 

Although the practice of this vice is not con- 
fined to boys of the nervous type, yet it finds 
in them victims the most willing, and the least 
able to resist the continually increasing de- 
mands of the habit. Boys of vigorous consti- 
tution, in whom the digestive and muscular 
systems are well developed, are less under the 
control of these erotic impulses, and are more 
able to resist the inroads of the habit when 
formed, because in them the exercises of youth 
and the satisfaction of the appetite occupy their 
minds. 

A- premature and unnatural development of 
the genital apparatus may give origin to the 
vice of masturbation. Mr. South has related an 
extraordinary case of premature puberty, in 
which involuntary losses occurred : — 

" When he was about four months old, the 
hair on the pubes began to grow very thickly 
and black, at which time the penis increased in 
size, particularly the glans, so that it gradually 
extended beyond the prepuce, till about fifteen 
months, when it was entirely exposed ; the pubes 
were then completely covered with black, curling 
hair Soon after this, she (his mother) 



noticed that his linen was stained two or three 

times in the week She also states 

that since he has been in town (six weeks) the 
emissions have been more frequent than for 
some time previously." * Mr. South gives the 
following measurements of the penis of this ex- 
traordinary infant : leogth of penis when pendent 
from the symphysis pubis, three inches ; length 
of penis when erect, six inches. This is probably 
the "most rare and curious " case of premature 
puberty on record ; certainly it is the earliest 
period at which spermatorrhoea has occurred. 
Such an instance is wholly exceptional. Never- 
theless, a premature development of the sexual 
organs may constitute an occasional cause of self- 
pollution — the more especially if such develop- 
ment be not accompanied by corresponding 
growth of the other organs and systems of the 
body, and of the reason and moral control. 

Independently, however, of a premature de- 
velopment of the sexual apparatus, the vice of 
masturbation may be contracted at a very tender 
age, a very instructive example of which has been 



*Medico-Cliirurgical Transactions, vol. xii., p. 7G. 

2 



Q SPERMATORRHOEA. 

narrated by Mr. Heckforcl. " I believe it is not 
generally known," says Mr. Heckforcl, " that 
this vice is practiced not only by adults of both 
sexes, but also by young children, and even in- 
fants in the cradle. The following notes, kindly 
given me by Dr. Hughlings Jackson, are a suffi. 
cient guaranty as to the correctness of this 
assertion, at least as regards one case. . . . 
The following is a narrative of Dr. Jackson : — 
A woman came in the Hospital for Epilepsy and 
Paralysis, on account of fits. She took the op- 
portunity of asking my advice about her child. 
The boy was fifteen months old ; he was delicate, 
and had never been able to stand ; but the special 
circumstance about which the mother wished to 
hear my opinion was the peculiar position of 
his legs. The right leg was almost always 
placed high up over the other, and he kept it 
moving in a sawing way towards the pelvis. The 
penis was in the way of friction, and was quite 
stiff when I examined it. He was much an- 
noyed at my interference wdth the movements 
of his leg, making resistance and crying. . . . 
The boy had congenital phymosis, but he did 
not cry when he made water. Mr. Hutchison 



CAUSES. 9 

was kind enough, at my request, to circumcise 
him. . . . After this the habit ceased, for a 
time at least, and the child much improved in 
health." * 

I have had lately under observation a case, a 
boy four years of age, who had practised the 
habit for two years. He exposed the penis to 
friction between the thigh and abdomen. His 
mother informed me that he was much excited 
during the act, and at its termination passed 
into a nervous state, preceded by a shudder. 
He had frequent epileptic convulsions. Circum- 
cision, although it interrupted, did not cure the 
habit, for the boy resumed it again after the 
wound healed. Threats, punishment, and re- 
straint were alike unavailing to prevent the per- 
petration of the act. 

A very influential cause in determining the 
habit of onanism is a redundant prepuce. Around 
the corona glandis, in the sulcus, are situated a 
number of sebaceous glands, the secretion of 
which, if allowed to accumulate, excites irrita- 
tion and itching. Erection and the venereal 

* London Hospital Reports, vol. ii., p. 58. 



10 SPEBMATOItEHCEA. 

orgasm follow the friction which is innocently 
used to allay the itching. Moreover, when the 
glans is habitually covered, it becomes mor- 
bidly excitable, and the least friction develops 
the special sensibility of its nerves. The occur- 
rence of herpetic eruptions is another impor- 
tant factor. The itching demands relief, and an 
innocent excitation develops into onanism. 

According to Sinion* {de Metz) various causes 
besides the foregoing increase the excitement 
of the genitals at puberty, among which he enu- 
merates prolonged sitting, as at school, which 
fatigues the spinal column and causes an accu- 
mulation of blood in the inferior parts of the 
trunk. " For the same reason," says Simon, 
" that clerks and persons who ride much on 
horseback or in carriages are exposed to hemor- 
rhoids, boys will experience excitement of the 
genitals in consequence of engorgement of the 
testes and spermatic cord." 

Patients frequently refer the origin of the 
habit of masturbation to the influence and exam- 
ple of older boys. In public institutions, where 

* Traite cVHygiene appliquee a V Education de la Jeunesse. 
Paris, 1827, p. 164. 



CAUSES. 11 

man}' boys of the more 'depraved sort are col- 
lected together, this may sometimes occur ; and 
even in the better class of boarding-schools a 
bad boy, given to this vice, may induce others 
to commence it : but generally speaking, the re- 
mark of Quintilian is true : Non accipiunt e 
scliolis mala ista, sed in scholas afferunt. The 
masturbator takes into the school those organic 
tendencies which lead to the perpetration of the 
vice. Possessing the erotic temperament, slight 
causes will suffice, at school or at home, to 
awaken the special sensibility of the sexual 
apparatus. 

Under what circumstances soever the vice of 
masturbation may be contracted, it is usually 
continued, and with increasing frequency, until 
weakness of the genital organs and various func- 
tional derangements are produced. The habit 
is discontinued, either because of some evident 
ill consequence which alarms the patient, or he 
is informed of the serious results which must 
finally ensue from his violation of a natural law. 
But the unfortunate victim finds that the cessa- 
tion or diminution of the habit does not restore 
him to the natural state. He cannot rid his im- 



12 SPEEMATOPJiHCEA. 

agination of the erotic fancies which have so long 
possessed it. During sleep lascivious dreams 
beset him, accompanied by the venereal orgasm 
and the seminal loss. During the day erotic 
ideas constantly invade his mind, and partial 
erections occur, followed by a tenacious dis- 
charge which slowly escapes from the urethra. 

It is probable, also, that spermatorrhoea may 
result from excesses in natural coitus. Cases 
apparently originating in this way have fallen 
under my observation. The history of these 
cases is as follows : After very free indulgence 
symptoms have occurred indicating the neces- 
sity for abstinence. This sudden and forced 
continence puts the mind of the individual and 
his genital apparatus in the same condition as 
that which occurs after the habit of masturba- 
tion ceases. We have on this point the high 
authority of Sir James Paget : " Now I believe 
you may teach positively, that masturbation 
does neither more nor less harm than sexual in- 
tercourse, practised with the same frequency, 
in the same conditions of general health, and 
age, and circumstances. Practised freely by 
the very young, that is, at any time before or 



CAUSES. 13 

at the beginning of puberty, masturbation is 
very likely to produce exhaustion, effeminacy, 
over-sensitiveness, and nervousness." — Clinical 
Lecture. 

The relation which spermatorrhoea bears to 
certain structural alterations of the genito -urin- 
ary organs requires to be carefully investigated. 
Very contradictory opinions have been ex- 
pressed on this point. 

By surgeons it is regarded as an affection — an 
inflammation or an irritation — of a part of the 
genitourinary apparatus, and the surgical treat- 
ment is based upon this pathological doctrine. 
One of the most recent and able of surgical 
authorities * treats of it under the heading of 
" functional disorders of the testicle." The 
modern surgical writers in general adopt this 
view, especially those accessible to the Ameri- 
can reader. t The work of Lallemand % is the 



* Holmes's System of Surgery — Art. Diseases of the 
Male Organs. Vol. iv., p. 539. Loudon. 1864. 

f Gross's System of Surgery, p. 831-2, vol ii. Phila. : 
1865. Erichsen's Surgery, p. 1224. A Practical Treatise 
on the Disease of the Testis, etc., by Curling. Phila. Ed., 
p. 326, et seq., etc., etc., etc. 

\ Des Pertes Seminales Involontaires, op. cit. Also, 01- 



14 SPERMATORRHEA. 

principal source of these pathological views. It 
will be proper, therefore, to present an outline 
of this author's doctrines before presenting our 
own. 

Views of M. Lallemand. — This author regards 
the following as playing an important role in the 
production of this disorder : Blenorrhagia and 
stricture of the urethra, the former affecting the 
prostatic part of the urethra and the orifices of 
the seminal ducts, and the latter producing dila- 
tation of the ducts by the efforts of micturition ; 
gouty and rheumatic affections occurring in 
these parts ; accumulation of sebaceous matter 
under the prepuce, constituting a source of 
irritation ; venereal excesses and masturbation, 
which act principally by provoking inflammation 
or irritation of the ducts ; prolonged erections 
excited by erotic ideas or lascivious publica- 
tions ; the use of diuretics, of ergot, of canthar- 
ides, etc. ; the abuse of alcoholic drinks, of 
coffee, and of tea ; constipation ; ascarides in 

serrations sur les Maladies des Organes Genito- Urinaires. 
Premiere Partie, p. 158, ei seg., 1825, by the same author. 
The influence of a" hobby " is well seen in the growth of 
M. Lallemand's opinions and practices during the fifteen 
years' interval between these works. 



CAUSES. 15 

the rectum ; hemorrhoids ; fissures of the anus ; 
heating and irritation of the anal and perineal 
regions by habitual sitting, or prolonged horse- 
back riding. 

The organic peculiarities which predispose to 
spermatorrhoea are, according to this author — 
excessive length of the prepuce ; hypospadias ; 
extraordinary size of the meatus urethrae ; flac- 
cidity of the corpora cavernosa ; smallness, tardy 
descent and lack of firmness of the testes ; re- 
laxation of the cord and of the scrotum ; vari- 
cocele ; congenital induration of the prostate, 
and great development of the pelvis with femi- 
nine characters. 

When the nocturnal pollutions are due to ex- 
cesses, to abuse, to the presence of ascarides in 
the rectum, they produce, according to Lalle- 
mand, grave disorders in a short time after their 
appearance. After a little, all the phenomena 
of excitation which precede or accompany the 
orgasm diminish, and finally completely disap- 
pear ; the act of emission occurring without 
erection, pleasure, or any particular sensation. 
The semen loses little by little its color, its odor, 
and its spermatozoa, and comes to resemble, 



16 SPERMATORRHEA. 

more and more, either mucus or the prostatic 
fluid. This progressive diminution in the exci- 
tation of the genital organs, and this increasing 
alteration in the sperm, correspond with a re- 
markable augmentation in the gravity of the 
general symptoms and in the difficulties in the 
treatment. At the same time the vesiculae semi- 
nales acquire the power of contracting under tbe 
influence of a less energetic excitement. Then, 
also, fullness of the bladder or rectum, a warm, 
soft bed, lying on the back, warm drinks, exci- 
tants, etc., provoke emissions more or less easily. 
The effects are much more serious when to the 
nocturnal are added diurnal pollutions. Some 
patients suffer only from nocturnal pollutions, 
but such cases are rare. 

The diurnal pollutions, according to Lalle- 
mand, are produced by all those causes which 
increase constipation and favor the excitation 
of the genital organs ; such as prolonged sitting, 
the jolting of a carriage, riding on horseback, 
etc. In some subjects the pollution does not 
take place passively during the efforts of defeca- 
tion, and by the simple effects of compression, 
but by the proper action of the ejaculatory ap- 



CAUSES. 17 

paratus. These cases are unusual. In all the 
others the semen is emitted without the sensible 
phenomena of ejaculation. The evil effects are 
determined by the abundance of the loss ; but 
some persons support the losses better than 
others. 

The varieties of nocturnal and diurnal pollu- 
tions manifest themselves successively or simul- 
taneously. The specific character is the sudden 
expulsion of semen in notable quantities at vari- 
able intervals. A symptom which has close 
relation to spermatorrhoea, and which ordinarily 
accompanies it, is impotence. In all cases of 
nocturnal or diurnal pollutions, the first symp- 
tom discovered is a notable diminution in the 
energy and duration of the erections, and an 
increased readiness of ejaculation. 

M. Lallemand gives the following result of 
his microscopic examinations of the excreted 
matters in the different varieties of seminal loss : 
" When the evacuations are rare and the semen 
has preserved its distinctive characters, the ani- 
malcules present nothing remarkable either in 
respect to numbers or dimensions. But when 
the spermatorrhoea has assumed sufficient im- 



18 SPERMATORRHOEA. 

portance to influence the rest of the economy, 
the semen becomes more liquid, and the animal- 
cules are less developed and less vivacious, al- 
though their number may not appear to be 
diminished. When the erections commence to 
diminish, the semen is more aqueous ; the di- 
mensions of the spermatozoa are sometimes 
one-fourth or one-third their normal size, their 
caudal prolongation being distinguishable with 
difficulty, with a power of 300 diameters." * 

The central idea of M. Lallemand's theory of 
the pathology of spermatorrhoea, is the produc- 
tion, by various causes, of an irritation or inflam- 
mation of the prostatic portion of the urethra and 
of the seminal ducts. This view is not supported 
by anatomical evidence. Although cadaveric 
examinations, as is well said by M. Raige- 
Delorme,f have resulted in the discovery of di- 
verse alterations of the genital organs in cases in 
which seminal losses icere presumed to have ex- 
isted, these alterations were so connected with 
important diseases of other parts of the genito- 
urinary apparatus, that little reliance can be 

* Op. tit., II., p. 404. 

f Dictionnaire de Mklecine, vol. xxviii., p. 506. 



CAUSES. 19 

placed in them as indicative of spermatorrhoea. 
These alterations consisted in ulcerations of the 
orifices of the ejaculatoiy ducts ; injection and 
ulceration of various parts of these canals ; anal- 
ogous alterations of the vesiculae seminales ; 
purulent depots in the vesicles, in the vasa de- 
ferentia, in the epididymis, in the body of High- 
more, and in the testicle. It is impossible to as- 
sociate these lesions with spermatorrhoea, since 
in all the cases cited they were accompanied by 
more or less grave alterations of the urinary pas- 
sages. One cannot avoid the reflection in look- 
ing over Lallemand's cases, published in his work 
on the genito-urinary organs in 1825, and in his 
work on seminal losses in 1839, that his cases as 
well as his theory were constructed to justify his 
practice. There is no proof that the anatomical 
lesions described by this author were causative 
of spermatorrhoea, or that they were even accom- 
panied by it. On the other hand, the observa- 
tions are numerous enough in which these altera- 
tions occurred without the production of sper- 
matorrhoea. The truth is, undoubtedly, that 
there is no specific anatomical element in all 
that Lallemand has submitted, to be associated 



20 SPERMATORRHOEA. 

indissolubly with that disorder, and to which it 
may be attributed. In support of our opinion, 
we may cite the high authority of Mr. Thomp- 
son,* who asserts that inordinate sexual in- 
dulgence cannot have the effect to produce pro- 
statitis unless gonorrhoea be already existing. 

I may also refer, in opposition to the views of 
Lallemand, to my personal observations. As 
pathologist to the Cincinnati Hospital, and dur- 
ing the time of my military experiences, I have 
had numerous opportunities to ascertain — if it 
exist — a causative relation between the lesions 
of the generative apparatus and spermatorrhoea 
described by Lallemand, but hitherto have failed 
to observe this connection. To place this ques- 
tion beyond controversy, I have lately made a 
most careful dissection of the sexual apparatus 
of a young man dead of a double pneumonia, 
who was known to have practiced masturbation 
in an extreme degree for many years. Besides 
a catarrhal condition of the mucous membrane 
of the seminal and prostatic ducts, and of the 
vesicidce seminales, there was literally no lesion 

* On Enlarged Prostate : Its Pathology and Treatment. 
London, 1858, p. 195. 



CAUSES. 21 

of these organs. I therefore reject this position 
of Lallemand as untenable, and as leading to 
improper methods of treatment. 

The views of Lallemand in regard to the alter- 
ations in the spermatozoicls, and their destruc- 
tion in advanced cases of spermatorrhoea, are 
hardly more tenable than his doctrine of the 
structural alterations peculiar to this disease. 
Liegeois, who has examined this question, re- 
marks : " My own observations (six cases) are 
not at all in accordance with the description 
given by Lallemand. Azoospermia existed in 
only one of my patients. The other five, though 
the involuntary emissions were frequent, and 
the virile faculties had materially diminished, 
though the affection had lasted from two to 
ten years, I have never found any change in 
the aspect, the consistency, or the odor of the 
seminal fluid, not even in the number or the 
configuration of the spermatozoa." * This ac- 
cords with my own observation. 

Spermatorrhoea is, in the view of the author, a 

* Tlie Seminal Secretion in Disease. Medical Times and 
Gazette, Nov. 6, 1869. 



22 SPERMATORRHOEA. 

neurosis. Although structural alterations may 
be coincident, tliey are not causative. It is cer- 
tainly true, however, that lesions of various parts 
of the generative organs may increase that dis- 
order of their nervous apparatus which finds ex- 
pression in frequent involuntary seminal losses. 
In order to a just comprehension of sperma- 
torrhoea, our inquiry must start from the physi- 
ology of the normal coitus. The seminal ejacu- 
lation is a reflex act. The sensation excited by 
the friction of the erect and turgid male organ is 
transmitted to the cord, and the impression is 
reflected over the testes, vesiculae seminales, ure- 
thra, and appended muscular apparatus, produc- 
ing the seminal ejaculation. The whole consti- 
tutes the venereal orgasm.* It approximates 
in many of its phenomena to epilepsy, and is 
accompanied in some persons with an epilepti- 
form seizure. This is more particularly exhibited 
in the act of masturbation, in which the excita- 



* Carpenter's Physiology, 5tlied., p. 794. Kirke's Physi- 
ology, p. 411. On this point the reader may consult with 
great advantage the elaborate work by Luys, entitled Re- 
cherches surle Systeme Nerveux Cerebro-Sjrinal, sa Structure, 
ses Fonctions, et ses Maladies. Paris, 1865, pp. 296 and 339. 



CAUSES. 23 

tion of the genital organs is more intense, the 
imagination more inflamed, and the orgasm more 
profound. There is a great expenditure of ner- 
vous force in a single act of coitus — much more 
so in the unlawful excitation — manifested by the 
languor, weakness, and mental feebleness which 
occur for some time afterwards. Of course, 
these effects will be experienced in a much 
greater degree when the orgasm is frequently 
repeated. 

The generative apparatus of the male and 
female has a very intimate relation with the ner- 
vous system. It is the impression which the 
individuals of each sex make upon the organs of 
sense that excites those desires which have coi- 
tus for their object. There is a corresponding 
influence of the genital organs upon the nervous 
centres ; for when semen accumulates in the 
reservoirs, the organs of generation transmit an 
influence to the cerebro-spinal centres, giving 
rise to sexual desire. 

" The glans penis," says Kobelt,* " is the prin- 
cipal point of reunion of the sensitive nerves of 

* Be Vappareil du sens genital. Strasbourg : 1851 ; quoted 
by Luys. 

3 



24 SPERMATORRHOEA. 

the virile organ ; no other part which it regu- 
lates can be compared with it in this respect. 
In respect to richness in nerves, the glans penis 
yields to no other part of the economy, not even 
the organs of sense.'' According to Kobelt,* 
the division of the dorsal nerve of the penis, in 
the most powerful and erotic stallion, deprives 
the animal of sexual desire as completely as 
castration. 

" Anatomically regarded," says Handfield 
Jones. " it is very remarkable how closely the 
different nervous centres, or parts of a nervous 
centre, are connected by commissural fibres ; 
and from a pathological point of view, the same 
connection is very manifest. The general ex- 
haustion induced by excess in venery ; the pro- 
duction of neuralgia in weakly persons by bodily 
exercise ; the effect of muscular exertion in caus- 
ing drowsiness — are examples which show how 
excessive consumption of nerve-force in one 
part weakens it also in others," etc. 

Experience has abundantly shown that the 
lesions resulting from masturbation are those 

* De I'appareil du sens genital. Op. cit. , as quoted by 
Luys. 



CAUSES. 25 

due to expenditure of nervous force and derange- 
ment of the intimate and harmonious relation 
existing between the sexual system and cerebro- 
spinal centres, and not to a mere loss of seminal 
fluid : for under no other circumstances is so 
small a discharge from the body accompanied 
by such serious results. This conclusion is 
further strengthened by the more important ef- 
fects which follow masturbation than sperma- 
torrhoea, although the mere seminal loss in two 
cases may be exactly equal. 

A marked feebleness of the intellectual facul- 
ties is observed after abuse ; other parts of the 
nervous system also participate in the debility 
of the encephalon. The organs of sense, espe- 
cially that of vision, lose their sensibility to 
their appropriate stimuli, and their functional 
activity is lowered. 

By masturbation, by excesses in venery, a 
condition of hyperesthesia of the glans and 
urethra is induced, and the reflex act of ejacu- 
lation becomes abnormally excitable. Under 
these circumstances erotic ideas are readily ex- 
perienced, and so promptly does the reflex func- 
tion of the cord respond, that the seminal loss 



26 SPERMATORRHOEA. 

may occur without a decided venereal orgasm. 
This is the essential pathological condition in 
spermatorrhoea. By frequent involuntary losses 
a habit is induced, and power diminishes. This 
idea has been well expressed by Handfield 
Jones : — 

" It seems a well-established fact that the 
nervous tissue, both in the centres and in the 
peripheral extensions, becomes more excitable 
and mobile in proportion as its power becomes 
weaker. The motor nerve is more readily thrown 
into action, though the impulse it communi- 
cates is weak, and cannot be long sustained."* 

The physiological origin of spermatorrhoea 
.must not be overlooked. As I have already in- 
dicated, adults in full health have emissions, 
when continent, more or less frequently, accord- 
ing to their sexual peculiarities. This sponta- 
neous evacuation is an effort of nature, under 
these circumstances, to supply the lack of use of 
a physiological function. That such occasional 
loss is physiological rather than pathological, 
seems confirmed by the good effects which ensue 

* Functional Nervous Diseases, op. cit., p. 48. 



CAUSES. 27 

from it upon the mental and physical constitu- 
tion of the individual. The inquietude of mind, 
the headache, and the hebetude of body which 
are experienced anterior to the evacuation be- 
come relieved hereby ; the muscular movements 
are then more easily executed; the headache 
ceases, and the mental operations are more 
rapid and clear. In some subjects, however, 
these evacuations may become so frequent and 
excessive as to constitute a pathological state. 
This occurs in clergymen, in studious persons of 
sedentary habits, and in those whose nervous 
apparatus has been deranged by dyspepsia. 
The excessive use of such stimulants as coffee 
and tobacco by continent persons who have 
weak digestion, slight muscular development, 
and a preponderating nervous system, power- 
fully contributes to the conversion of a physio- 
logical into a pathological spermatorrhoea. 

Moral. — Foremost amongst the moral causes 
must be placed the indulgence in lascivious 
thoughts, which acts by maintaining a state of 
turgescence of the sexual apparatus. 

During this condition of excitement semen is 
abundantly secreted, and accumulating in the 



28 SPERMATORRHOEA. 

vesiculce seminales, must find an outlet by the 
nocturnal loss. Frequent repetition of this ex- 
citement induces that condition of irritability of 
the sexual organs, the essential cause of sper- 
matorrhoea. Similar to this in all respects is 
the effect of that venerea l excitement caused by 
taking liberties with the opposite sex without 
the gratification of desire. The intimate rela- 
tion which exists between parties " engaged to 
be married," if long continued, frequently pro- 
duces the same condition of genital weakness. 



SYMPTOMS. 29 

SYMPTOMS. 

The signs and symptoms of spermatorrhoea 
may be divided into the objective and subjective, 
the objective being those which are recognized 
by the physician ; the subjective those of which 
the patient himself only is conscious. It is not 
always possible to separate the symptoms due 
to masturbation from those of spermatorrhoea. 
There is a practical utility in placing them side 
by side for the purpose of comparison. The two 
conditions are so frequently united, and the 
connection between them of cause and effect so 
intimate, that the symptoms of both may be 
comprehended in the experience of the same 
individual. It is to be remarked that the vol- 
untary seminal losses by unnatural means are 
much more active in producing the various 
secondary phenomena of this disorder, than the 
involuntary. The former are manifested, also, 
by more positive objective signs. 

Objective Symptoms due to Masturbation. 
— Objectively considered, the masturbator is 
recognized by a marked facial expression, by a 



30 SPERMATORRHOEA. 

characteristic mannerism, and by a peculiar 
mental state. 

The facial expression consists of a pale and 
sallow tint of the skin, unusual development of 
acne, especially on the forehead ; a dark circle 
around the orbits ; dilated and sluggish pupils ; 
lustreless eyes, and an oblique line extending 
from the inner angle of the lids transversely 
across the cheek to the lower margin of the 
malar bone. The face has a haggard, troubled, 
furtive expression. These signs of themselves 
are by no means conclusive, for they may be 
produced by other causes than masturbation. 
This observation is especially true with respect 
to acne. This eruption occurs at puberty, more 
or less abundantly in different temperaments; 
and hence it would be very unjust to accuse 
young men of practising onanism in whom no 
other evidence of the fact existed than the 
presence of this eruption. 

The manner of the masturbator is peculiar. 
He is listless, shy, retiring, and easily con- 
fused ; he avoids society, preferring solitude ; 
there is a w T ant of steadiness and decision in 
his locomotion ; his inferior extremities seem 



SYMPTOMS. 31 

deficient in power, and all his movements be- 
tray a mind ill at ease. 

His mental operations are confused ; his 
speech is embarrassed, awkward, and without 
directness ; his memory is defective, and he is 
absent-minded and given to reverie. If the 
habit has long existed, and been excessively 
frequent in repetition, epilepsy may be pro- 
duced ; or serious mental disorder, as delu- 
sional insanity, dementia, etc., may occur. 

The state of the genital organs varies with 
the length of time the habit has been indulged. 
In some young subjects, there will be observed 
an extraordinary development of the organs, 
owing to premature excitement ; but the dis- 
proportion is not maintained. With the prog- 
ress of the habit the penis becomes relaxed, 
the erections feeble: the corpora cavernosa 
either atrophy, or their vessels lose their toni- 
city, whereby an apparent diminution in bulk 
takes place ; the corpus spongiosum and the 
glans also shrink, so that the prepuce appears 
unnaturally elongated. The testes may in- 
crease in size, become tender and " irritable," 
or they may undergo a certain degree of 



32 SPERMATORRHOEA. 

atrophy; the latter is the more usual re- 
sult. 

The superficial veins of the penis, especially 
the dorsal vein, dilate and become tortuous. 
Their capacity is so much enlarged, that the 
penis is emptied of blood with unnatural ra- 
pidity ; hence the erections cannot be long 
maintained. A considerable increase of capa- 
city — how much the data do not warrant an 
opinion — of the efferent vessels, notably the 
dorsal, may prevent that degree of filling of 
the veins necessary to constitute an erection. 

Subjective Symptoms due to Masturbation. 
— Pains in the lumbar region, a sense of weight 
and aching in the loins, around the anus, and in 
the testes, are experienced. The appetite is ca- 
pricious, the digestion feeble, and the bowels 
are constipated, or constipation alternates with 
diarrhoea. 

The mind is deficient in power of attention ; 
the imagination is constantly pervaded with 
vague erotic dreams, the moral sense is blunted, 
and the perceptions are dull and confused. 
Pains in the head, in the occipital and frontal 



SYMPTOMS. 33 

regions, and a sense of fulness, and in serious 
cases alarming vertigo ; pains in the course of 
the principal nerves, and an extreme nervous 
susceptibility are experienced. The organic ner- 
vous system manifests a functional disturbance 
in harmony with the disorder of the nervous 
system of animal life. Gastralgia and abdomi- 
nal pain and uneasiness are in some cases very 
distressing symptoms. 

The distinctiveness of the foregoing symptoms 
will be determined by the extent and duration 
of the habit, and by the constitutional peculi- 
arities of the patient. The more highly devel- 
oped the nervous system, and the more it pre- 
ponderates in activity over the muscular and 
digestive systems, the more serious the effects. 

Objective Symptoms of Spekmatokkhom. — 
These are in many respects similar to those due 
to masturbation. The same cause, indeed, is in 
operation, but is much less powerful. 

The facial expression is not so marked. Acne 
is not common. The discoloration of the eye- 
lids is decided only in cases of very frequent 
seminal loss. The face is usually pale, sallow, 



34 SPERMATORRHOEA. 

and thin, anxious or sad in advanced cases. 
The manner is more or less retiring, subdued, 
and melancholy. Effeminacy, and sometimes 
extreme pusillanimity, are observed. Society is 
distasteful, or is absolutely avoided. Memory 
and power of attention are defective, and the 
patient is subject to fits of depression and mel- 
ancholy, and is absorbed in the contemplation 
of his infirmity. These mental effects are fre- 
quently greatly disproportioned to the real im- 
portance of the malady; they are increased by 
popular works on this subject, for the perusal of 
which these patients have a prodigious penchant. 
They imagine themselves possessed of every in- 
firmity portrayed in these works, and are not 
unfrequently driven to the verge of insanity by 
their apprehensions. Hypochondria is a very 
constant mental symptom ; but true mental 
alienation is not, by any means, so frequently 
observed as in masturbation. 

The gen tal organs are relaxed, the scrotum 
pendent, the veins of the spermatic cord vari- 
cose, the erections deficient in power and dura- 
tion, and the seminal fluid is thin, watery ; the 
spermatozoa are deficient in size and activity, 



SYMPTOMS. 35 

and are imperfect in development. The urine 
is pale, of low specific gravity, and loaded with 
urates. An evident feebleness of the general 
system exists, manifested by a quick, weak 
pulse, cold hands and feet, hurried respiration, 
and loss of flesh and muscular vigor. 

Subjective Symptoms oe Spermatobkhcea. — 
Weakness in the back and pain extending up- 
wards to the scapula ; pain along the spermatic 
cord, in the hips, around the anus, and pain in 
micturition, are experienced by the patient. He 
has a variable appetite, and ''suffers from dys- 
pepsia, borborygmi, constipation, and diarrhoea. 
He complains of weakness in the knees, with 
pain and soreness of the calves, and loss of 
power in the inferior extremities. His sensa- 
tions in these parts may be perverted. He 
has also headache, or a sense of fulness in the 
head ; he can fix his mind on any subject with 
difficulty ; his attention wanders, and he is given 
to day-dreams and to erotic visions. 

The importance of the foregoing symptoms 
will be governed by the frequency of the spermal 



36 SPERMATORRHOEA. 

losses. They are felt in the greatest intensity on 
the morning succeeding the noctural emissions. 

The essential symptom in spermatorrhoea is 
the occurrence of seminal losses. Lallemand, 
and succeeding writers following him, divide 
these into nocturnal and diurnal pollutions. The 
nocturnal occur at night in an erotic dream, 
with a more or less decided venereal orgasm ; 
and their importance, in a pathological point of 
view, will be wholly determined by the frequency 
of their occurrence, and the evident derange- 
ments of the organism which precede or accom- 
pany them. 

The diurnal pollutions, according to Lalle- 
mand, occur principally in micturition and defe- 
cation; passively in some subjects, owing to a 
superabundance of semen in the vesiculse se- 
minales ; in others with a certain pleasure and 
a definite ejaculation ; and in others, habitually, 
without sensation, with a feeble or scarcely per- 
ceptible ejaculatory effort. The first variety 
can hardly be regarded as pathological. 

It is peculiarly unfortunate that these views 
of M. Lallemand, with reference to diurnal pol- 
lutions, have obtained such general credence. 



SYMPTOMS. 37 

The minds of patients become so impressed 
with the conviction that every mucous flow 
from the uretha is seminal, that it is difficult to 
overcome it. They parade this symptom and 
dwell upon it, believing that it has the patho- 
logical significance which Lallemand and his 
followers have ascribed to it. 

The various symptoms of spermatorrhoea may 
be comprehended in three groups : genital ; cer- 
ebral; spinal. 

In the first, or genital form or phase, which 
is the most common, there are excessive sensi- 
bility of the sexual apparatus, and greatly in- 
creased reflex excitability of the cord. 

In the cerebral form there are associated 
with the preceding conditions certain disorders 
of the mind — melancholia, delusional insanity, 
and mania. 

In the spinal form the functional derange- 
ment of the cord is either excessive and pro- 
nounced, or has resulted in organic lesion. 

I. — GENITAL FORM. 

The sexual organs are relaxed ; the testes 
tender, painful, and sometimes wasted ; the 



38 SPERMATORRHOEA. 

erections feeble and the seminal flow watery. 
Slight causes — an erotic idea, gentle friction, a 
voluptuous dream — will produce a feeble erec- 
tion followed by a quick emission with but little 
sensation. Whenever an erection and an emis- 
sion occur, there is an evident orgasm, but not 
nearly so pronounced as in the normal state. 
After every erection without seminal loss, there 
is a mucous flow from the urethra. A mixture 
of this mucus with the semen produces the so- 
called watery semen. The same mucous dis- 
charge is not unfrequently observed after uri- 
nation and defecation. It alarms the patient 
because he has been led to believe that it is 
seminal. These are the cases to which M. 
Lallemand applies the term "diurnal pollu- 
tion." If a proper examination of this fluid be 
made, it will be found not to contain spermato- 
zoa. It is a thick, transparent, albuminous fluid, 
alkaline in reaction, and presents under the 
microscope the cellular elements noted in Fig. 
1. We need hardly remark that the presence 
of spermatozoa (Fig. 2) is essential to prove 
the existence of semen. No other test is at all 
applicable to the determination of this ques- 



SYMPTOMS* 39 

tion, than the microscopic. It cannot be de- 
nied that spermatozoa may be found in the 
urine or mucous secretion from the urethra, 
if a nocturnal emission, or an emission pro- 
duced by natural or unnatural means, have 
recently occurred; but these fluids should be 
examined, when this source of error may be 
eliminated. We are glad to have an oppor- 
tunity of quoting in support of our opinion so 
able an observer as Prof. Flint,* who remarks 
on this subject — "In the most of these cases 
the fluid is either the liquor prostaticus or a 
secretion from the vesicuke seminales. The 
microscope affords the only mode of determin- 
ing that the fluid is seminal. Were this mode 
of examination generally adopted, cases of sper- 
matorrhoea would be extremely rare." We quote 
further some excellent remarks on this subject 
from Hassell : f " Care must be taken not to 
coufound the discharge of urethral gleet with 
the seminal fluid ; the distinction is easy, since 
the former is distinguished by the absence of 
infusoria, by the presence of scaly epithelium, 

* Practice of Medicine : H. C. Lea. Phila., 1866. 
f The Urine in Health and Disease. London, 1863. 

4 



40 SPERMATORRHOEA. 

and by the escape being in general continuous. 
Sometimes the gleet y discharge occurs only 
after sexual excitement and lasts but for a 
short time, when, of course, its character is 
more apt to be mistaken. The prostatic fluid 
might also be mistaken for semen ; in this the 
spermatozoa would also be absent, and in addi- 
tion, the microscope would reveal in it the 
presence of the prostatic cylinders, and per- 
haps, also, of the peculiar lamellated concre- 
tions of phosphate of lime, which are found in 
the prostate in such numbers. Like the mucus 
from ordinary gleet, that from the prostate may 
also be continuous, but more frequently it ap- 
pears only after violent efforts at defecation, 
when a small quantity of matter may be ex- 
pressed, forming only a drop or two, of a thick, 
stringy, and transparent fluid, which appears at 
the orifice of the urethra." Dr. Chambers,* in 
a lecture delivered at St. Mary's Hospital, ex- 
pressed his conviction that this mucous flow 
from the urethra has no more pathological sig- 

* Lecture on Gonorrhoea and JmagiDary Spermatorrhoea, 
delivered at St. Mary's Hospital, June 14, 1861. Lancet, 
1861. 



SYMPTOMS. 41 

nificance than the leucorrhoea of woman. He 
further asserts that true spermatorrhoea is a 
rare, almost unknown disease, but he evidently 
here refers to that constant stillicidium of se- 
men to which Lallemand gave the name diurnal 
pollutions, and which many writers consider, but 
erroneously, the true spermatorrhoea. Again, 
Dunglison * says, " the presence of such a fluid 
in these circumstances, by no means shows that 
it is sperm. Indeed, it probably rarely is so, 
and is nothing more than the mucous fluid from 
the prostate or Cowper's glands." It seems a 
labor of supererogation to multiply authorities 
on this point. There can be no question that 
this mucous fluid is derived from the prostate, 
vesicuhe seminales, Cowper's glands, and from 
the follicles of the urethra. The frequent ex- 
citement accompanied by increased blood sup- 
ply, to which these parts are subjected, must in- 
duce a greater secretory activity in their glan- 
dular appendages. Hence we should expect to 
find blennorrhagia in cases of masturbation or 
spermatorrhoea. The urethra is red, injected, 

* Cyclopaedia of Practical Medicine. Am. Ed., Vol. II., 
p. 212. 



42 SPERMATORRHOEA. 

and exceedingly sensitive, and considerable irri- 
tation is referred to the region of the neck of 
the bladder and prostate gland. No other ana- 
tomical lesions can, with propriety, be attributed 
to spermatorrhoea. If any other be present, 
they are merely accidental or accessory and not 
essential. In this category may be placed those 
lesions described by Lallemand: thickening 
and stricture of the urethra, ulceration of the 
seminal ducts, suppuration in the prostate, 
etc. 

The phenomena of the genital form will be 
better exhibited by an illustrative case. 

Case I. — This was a patient, aged 32, who had 
practised masturbation with great frequency as a 
youth, but on learning the evil consequences had 
resolutely abandoned the habit. He afterwards 
suffered from frequent nocturnal emissions, and 
had, finally, such sensitiveness of the genital 
organs, that the slightest excitement produced a 
feeble erection and ejaculation. After micturi- 
tion and defecation he had a thick, tenacious 
discharge, which gave him great concern. He 
had, also, considerable irritation of the bladder, 



SYMPTOMS. 43 

pain and aching about the anus, in the back and 
loins. He was pale and thin ; his appetite was 
capricious, and he suffered much from constipa- 
tion, pain in the abdomen, borborygmi, and 
flatulence. His pulse was quick ; hands and 
feet cool and damp. His special senses were 
unimpaired ; he had no mental aberration in 
any form ; he was despondent and brooded over 
his sexual condition, fearing impotence. Al- 
though more easily fatigued than usual, he was 
still capable of very considerable exertion, His 
sexual desire was not materially lessened, for 
he had contracted a marriage engagement with 
which he feared to comply. His fears had been 
aroused by advertisements in the newspapers 
and popular works on his malady, for the read- 
ing of which he had the usual propensity. His 
organs were not materially damaged. The pre- 
puce was long and the penis lax; the left testis 
was somewhat atrophied, owing, probably, to a 
varicose condition of the veins of the cord on 
that side. 

The cases of the genital form of spermator- 
rhoea vary very much in importance. They 



44 SPERMATORRHOEA. 

occupy all possible intermediate gradations 
between the pale and emaciated subject who 
suffers from nightly pollutions and severe gas- 
tric and cardiac symptoms, and the plethoric 
subject whose weekly nocturnal loss is an ex- 
pression of a necessity of his sexual nature. 

II. — CEREBRAL EORM. 

The most serious mental effects are produced 
by masturbation. This vice, commenced at the 
period of puberty, interferes seriously with the 
development of the brain and the evolution of 
the mental faculties. We have already seen 
that this sad habit is contracted by those in 
whom the nervous apparatus predominates in 
activity over the muscular and digestive, and in 
whom the imaginative faculties are more highly 
cultivated than the reason and judgment. The 
mental effects of spermatorrhoea are also marked 
in those cases which we have denominated the 
cerebral. 

It is to be remarked that the mental pheno- 
mena of spermatorrhoea are not always in pro- 
portion to the seminal losses. In the cerebral 
form in addition to those lesions of the sexual 



SYMPTOMS. 45 

spinal system, of the digestive apparatus, and 
of the circulation described under the genital 
form, there are certain disorders of the mind. 
That spermatorrhoea will produce in one class 
of cases mental disorders, and not in another, 
indicates either that some predisposition to 
these disorders existed, or that the habit of self- 
pollution was merely an expression of mental 
alienation. The lascivious images which per- 
vade the minds of boys possessed of the highly 
developed nervous organization of masturbators 
are those of delusional insanity. In one case 
the spermatorrhoea is a symptom of mental dis- 
order ; in the other, the spermatorrhoea is an ex- 
citing cause — the predisposition already exist- 
ing. 

There is, however, a cerebral phase of sper- 
matorrhoea which may be separated from the 
two preceding classes. It is characterized by 
indistinctness of vision, dilatation of the pupil, 
amblyopia, diplopia ; diminution in the sensi- 
tiveness of the auditory apparatus ; feebleness 
of voice ; mental preoccupation, hebetude of 
mind, confusion of ideas, and a profound melan- 
choly. " Patients who have been laboring un- 



46 SPERMATORRHEA. 

der spermatorrhoea for a series of years are 
much more liable to hypochondriasis and cere- 
bral affection than to tabes dorsalis," says 
Romberg.* Not only do long-continued and 
excessive seminal losses produce these cerebral 
symptoms, but they may occur in those un- 
happy individuals who have acquired very false 
and highly-colored views of their condition from 
popular works on the subject. The termina- 
tion of such cases is in suicidal monomania, de- 
lusional insanity, etc. 

In that variety of the cerebral form in which 
a decided predisposition must be admitted to 
exist, to disorder of the intellectual faculties, 
there are found various forms of mental aliena- 
tion. The chronic form is the most common, 
which corresponds to the melancholia of Pinel, 
or the lypemania of Esquirol, terminating in 
dementia. Several of the most characteristic 
cases which have happened under my observa- 
tion correspond to the delusional insanity of 
Bucknill and Tuke.t Many writers are dis- 
posed to underrate the importance of this ten- 

* Vol. II., p. 400. 

f Manual of Psychological Medicine. Pkila. Ed., p. 103. 



SYMPTOMS. 47 

dene j in spermatorrhoea. To the influence of 
quack advertisements and popular works, which 
of course, greatly exaggerate the evils of this 
disease, is ascribed the melancholy, the hypo- 
chondriasis, and other mental disorders, which 
occur in the course of it. The statistics of any 
of our large insane asylums will illustrate the 
influence of masturbation in the production 
of mental alienation. We have already given 
the opinion of Romberg on this point. Mr. 
Holmes Coote, in a discussion which followed 
Dr. Drysdale's paper on the " Medical Aspects 
of Prostitution," read before the Harveian 
Society of London, remarked that " he still 
entertained the opinion that there were worse 
evils appertaining to human weakness than 
prostitution. He had opportunities of wit- 
nessing the fact that among the young there 
was no cause of insanity more common than in- 
dulging in habits w T hich he would not further 
particularize, but which were knowm to result 
in the most complete bodily and mental pros- 
tration." * Dr. John P. Gray, the distinguished 
Superintendent of the State Asylum at Utica, 
* British Medical Journal, Feb. 17, 1866. 



48 SPERMATORRHOEA. 

New York, thus speaks * of the influence of 
masturbation in the production of insanity : — 
" The records of this institution show five hun- 
dred and twenty-one cases admitted directly at- 
tributable to this vice, and I am well convinced 
that the number is greatly understated." • We 
might add confirmatory testimony from a va- 
riety of sources, but the foregoing is sufficient 
for our purpose. 

The cerebral form is exhibited in the follow- 
ing typical cases : — 

Case II. — Was a young man admitted to St. 
John's' Hospital as a private patient ; set. 30 ; 
five feet five inches high ; leuco-phlegmatic 
temperament ; beard scanty ; hair thin. At 
the time of admission he could not give a 
rational account of himself. His eye was wild ; 
pupil very much dilated; face pale, thin, and 
haggard. He walked unsteadily because of 
disturbance of cerebral circulation ; he was 
" dizzy." At night he was given up to various 
hallucinations ; he did not sleep, but spent the 

* Twenty-fourth Annual Eeport. 1867. 



SYMPTOMS. 49 

night in talking in a wild and incoherent man- 
ner, in wandering about his room, and beating 
upon the walls. Daring the clay he was quiet, 
but his conversation was disconnected,, his 
ideas wandering, and his speech confused. 
His appetite was capricious, his bowels consti- 
pated, and he had suffered greatly from bor- 
borygmi and abdominal pain. From his brother 
it was ascertained that he had been greatly ad- 
dicted to natural and unnatural venereal ex- 
citement, and had suffered lately from frequent 
involuntary losses. The state of his genital 
organs confirmed this. 

Case III. — Was similar to the preceding — a 
young man who had passed several years in 
the military service, during which time he had 
indulged very freely in the vice of masturba- 
tion. He was led to St. John's Hospital by a 
comrade ; he could not walk without support, 
in consequence he said of "lightness of his 
head." He had neither delirium nor hallucina- 
tions, but he was reduced to a state of mental 
feebleness bordering on dementia. He was 
pale, thin, and had little appetite ; his vision 



50 SPERMATORRHEA. 

was indistinct ; his pupils were dilated, and his 
hearing was dull and indistinct. All of his 
senses, indeed, were in a state of torpor. He 
admitted a degree of self-abuse, extending over 
several years, too revolting to be narrated, and 
had lately, after discontinuing it, suffered from 
a pitiable degree of seminal weakness.* 

III. — SPINAL FORM. 

Impairment of locomotion and spinal pa- 
ralysis have long been associated with venereal 
excesses. The progressive spinal paralysis, 
the tabes dorsalis of the Germans, and the 
ataxie locomotrice progressive of Duchenne, was 
formerly confounded with the effects of mas- 
turbation and excesses in venery. The differ- 
ential diagnosis will be a subject for future con- 
sideration. 

In the spinal form of spermatorrhoea there 
are weakness of inferior extremities, altered — 
diminished or perverted — and referred sensa- 
tions, incontinence of urine and faeces, and 

* Both of these cases formed the subject of a Clinical 
Lecture at St. John's Hospital, before the class of the 
Medical College of Ohio. Session of 1865-1866. 



SYMPTOMS. 51 

sometimes paraplegia. These symptoms are 
additional to those described as pertaining to 
the genital form ; they may also be superadded 
to the cerebral. In the following typical case, 
it will be seen that the spinal symptoms were 
distinctive. 

Case IV. — A travelling showman, set. 35, came 
under my care, suffering from weakness, with 
perverted sensations of both inferior extrem- 
ities. He had an ill-conditioned ulcer on 
the right leg ; slight pressure, as of riding on 
horseback, induced intractable ulcerations of 
buttocks and thighs. He had also, to a limited 
extent, incontinence both of urine and faeces. 
The sensibility of the skin, as to touch, pain, 
pressure, and the electric current, was dimin- 
ished. He had a sense of formication in his 
legs and tingling in his feet. The tendo-achillis 
of each side was a little shortened. He volun- 
teered the information that earlier in life he 
had been much addicted to onanism, and 
that since the habit was discontinued he had 
suffered from frequent nocturnal emissions. 
His mental powers w 7 ere unimpaired. He had 



52 SPERMATORRHEA. 

the unavoidable depression and anxiety arising 
from his very miserable physical condition, and 
nothing more. 

In what does the spinal lesion consist in 
these cases ? We have stated that the impor- 
tant pathological condition in the genital form 
of spermatorrhoea is a morbid excitability of 
the reflex faculty, with anaemia, probably of 
the cord. In the spinal form there is probably 
some structural lesion inappreciable by our 
ordinary means of investigation, a molecular 
change, possibly, or the nervous phenomena 
are of the reflex character. We have, however, 
no anatomical facts on which to base the for- 
mer opinion — our knowledge of these cases 
being entirely clinical; but the symptoms and 
the results of treatment seem to confirm our 
view of the pathology. Schroeder van der 
Kolk,* also, has made some observations which 
tend to establish the same view. Says this 
able observer : " Onanism is commonly consid- 
ered, and often correctly, to be a cause of 
epilepsy : but onanism and excitement of the 

* On the Minute Structure and Functions of the Spinal 
Cord and Medulla Oblongata. Syd. Soc. Translation, p. 268. 



SYMPTOMS. 53 

sexual organs are, to a greater degree than is 
usually supposed, the result of irritation and 
congestion of the medulla oblongata. The 
opinion formerly advanced by Gall, as to the 
localization of the sexual impulse in the cere- 
bellum, has been 'sufficiently refuted, and the 
close relation between the medulla oblongata 
and the action of the genital organs, is gener- 
ally received by physiologists. Let it suffice 
to call to mind the occurrence of erection and 
emission in persons hanged, how the sexual 
action is exalted in idiopathic mania with irri- 
tation of the brain and medulla oblongata ; how 
frequently, after injuries of the part, erection 
and emission, or perhaps impotence is observed. 
* x * * j n ^ e case f epilepsy I have 
just recorded, this influence was very evident ; 
the emissions disappeared for a time, when the 
sensibility and over-irritation of the medulla 
oblongata had again discharged themselves in 
a fit. * * * It is but a short time since a 
similar case occurred to me, of a young man 
who was unable to continue his studies regu- 
larly on account of epilepsy, apparently origi- 
nating in onanism. A few days ago I received 



54 SPERMATORRHOEA. 

a report, that for the last three months, after 
an issue had been by my advice established in 
the neck, neither the involuntary pollutions, 
which in this case also were very frequent, nor 
the epileptic attacks, which commonly returned 
every two or three weeks, had again appeared, 
while the patient's head had become much 
clearer, and he was able to continue his studies." 

On the other band, Gull relates* a case of 
complete paraplegia, produced by sexual ex- 
cess, in which no structural alteration of the 
cord could be detected even by the most care- 
ful microscopic examination. This case is justly 
regarded as exceptional. 

The state of the spinal cord in these cases 
may be quite different — the opposite, indeed, of 
that usually supposed to exist. The frequent and 
excessive discharges of nervous force may ex- 
haust the cells of the grey matter, and render 
them incapable, for the time being, of func- 

* Guy's Hospital Reports, 3d Series, Vol. IV., p. 175. 
Gull's language is as follows : " But on the most careful 
microscopical examination nothing abnormal was discov- 
ered in the texture, either at these parts or in any other, 
though the cord was submitted to repeated and searching 
examination by the microscope." 



SYMPTOMS. 55 

tional activity. Just as the electric eel is de- 
prived of its power of resistance by exhausting 
the stored-up force in its electric organ ; just 
as a permanent magnet is deprived of its mag- 
netic property by a powerful blow, so the spinal 
cord may lose by over-stimulation its power 
to functionate. In the condition supposed, the 
change is not in the vascular supply, but in the 
nerve cells. In that case, the minutest exam- 
ination may fail to disclose any structural 
alteration, as the closest inspection of the per- 
manent magnet will fail to discover any differ- 
ence in its appearance or quality. 
5 



56 SPERMATOERHCEA. 



RESULTS. 



I have already sufficiently shown that various 
forms of mental derangement may accompany 
frequent involuntary losses. I need not waste 
space by recapitulating the observations on this 
topic. 

An ordinary result of spermatorrhoea is weak- 
ness of mind. The brain acts slowly and imper- 
fectly, because a large part of the produced nerve 
force is consumed in the frequently repeated 
venereal orgasm. These patients are dull and 
listless. To accomplish a given amount of in- 
tellectual labor, they find that an unusual effort 
is necessary. They are given to reverie, and to 
vague and shadowy dreams in which erotic phan- 
tasms play. They take little interest in business 
and in the affairs of life, and to this cause is 
to be attributed, in many instances, unexpected 
failure in business and professional pursuits. 
They are men of dreams instead of men of ideas 
and action. This condition of the mental and 
moral forces is a more frequent result of sper- 
matorrhoea than mental derangement, properly 
speaking. 



RESULTS. 57 

I have not observed any disorder of the special 
senses beyond the diminished sensibility due to 
increased consumption of nerve force in the 
sexual system. 

The respiration becomes more or less irregular. 
Frequent deep inspiration, sighing, and a dry 
cough are often observed. Dryness of the fau- 
ces, especially of the posterior wall of the pha- 
rynx, and huskiness of voice also occur. I can- 
not say that I have observed phthisis to be pro- 
duced by spermatorrhoea, neither do I believe 
that such result is probable ; but, on the other 
hand, it is certainly true that if a tendency exist, 
hereditary or acquired, to this disease, frequent 
involuntary losses may promote its development, 
as indeed any cause may, which lowers the vital 
forces. 

Irregular action of the heart is most common. 
Pains are felt in the precordial region, the 
rhythm of the heart's movement is altered, and a 
subjective sense of fluttering is felt. These phe- 
nomena are frequently accompanied by a sense 
of constriction of the throat — a globus hysteri- 
cus — a tendency to shed tears, and the emission 
of a plentiful quantity of pale urine. 



58 ' SPERMATORRHEA. 

The most serious results of spermatorrhoea are 
those produced in the generative organs them- 
selves. Amongst these are impotence, "irritable 
testis," varicocele, and a state of hyperesthesia 
of the spermatic plexus. Impotence should not 
be confounded with loss of procreating power. 
A man is said to be impotent when he is unable 
to perform the act of coitus. Capacity for sexual 
intercourse may exist without the power of pro- 
creation. The practice of masturbation, or sper- 
matorrhoea, more usually results in impotence 
than in a mere loss of procreating power. 

Long-continued excitation of the generative 
organs, whether by natural or unnatural means, 
so inflames the imagination and exalts the reflex 
faculty that emission occurs before intromission 
of the male organ can take place, or after very 
imperfect coitus. The latter is the more usual 
condition for which the physician is consulted. 
Patients are peculiarly fearful and sensitive on 
this point. The morbid apprehension under 
which they labor, greatly increases their incom- 
petence. In some instances, without being at all 
seriously damaged in their sexual function, they 
are rendered temporarily impotent by the mere 



KESULTS. 59 

dread of failure. The London quack, Dr. Gra- 
ham, understood the influence of the imagina- 
tion upon the sexual congress. "Amongst the 
furniture of the 'Temple of Health' was a ce- 
lestial bed, provided with costly draperies, and 
standing on glass legs. Married couples who 
slept on this couch were sure of being blessed 
with a beautiful progeny. For its use, one hun- 
dred pounds per night were demanded, and nu- 
merous persons of rank were foolish enough to 
comply with the terms." * 

The impotence of spermatorrhoea is not a per- 
manent condition, unless serious cerebral or spi- 
nal complications have occurred. Ordinarily, 
the capacity for coitus returns with the cessation 
of the seminal losses — the evidence of a healthy 
functional state of the spinal cord. The loss of 
procreating power is not a frequent accompani- 
ment of seminal weakness ; the difficulty is in 
the intromission of the organ. Every practical 
physician is cognizant of instances of men whose 
semen had fertilizing power, but who were 
almost incapacitated for the sexual congress, 

* A Book about Doctors. JeafEreson, p. 338. 



60 SPERMATORRHEA. 

by reason of a great excitability of the reflex 
faculty. 

The same condition may exist as a result of 
long continence in ardent temperaments. But 
these cases only require a little time and famil- 
iarity with the object of desire. 

Excluding from consideration those organic 
deficiencies which may produce impotence, "as 
foreign to the purpose of this work, it will suffice 
to allude to varicocele, and so-called " irritable 
testes," when they are due to sexual abuses. 

It is exceedingly doubtful whether varicocele 
confined to the left testis ever results in impo- 
tence. Some instances have occurred under my 
observation in which this disease produced atro- 
phy of this testis, accompanied by a painful state 
of the right organ, and eventually resulting in 
almost complete extinction of sexual desire. In 
those exceptional and rare cases, where the vari- 
cocele is double, and atrophy results, impotence 
necessarily occurs. 

To the increased activity of the testes in secret- 
ing semen, has been attributed the varicose con- 
dition of the spermatic veins in spermatorrhoea. 
This view is hardly tenable. As the varicocele 



EESULTS. 61 

occurs on the left side almost invariably, in con- 
sequence of an anatomical peculiarity, and as it 
is not a constant nor even a frequent complica- 
tion, we may consider its presence, in general, as 
accidental. Opposed to this view, we should not 
omit mention of Mr. Hutchison's* opinion, that 
varicocele is of spinal origin. Dr. Hughlings 
Jackson t has reported a case which seems to 
confirm this opinion of Mr. Hutchison. 

The relation of " irritable testis " to impotence 
is much more immediate. By this term, Sir 
Astley Cooper,J to whom we are indebted for 
the most of our information on this subject, in- 
tended to express a state of hyperesthesia of the 
spermatic plexus. One or both testes are pain- 
ful, sometimes exquisitely so, tender to the touch, 
and occasionally swollen. The epididymis and 
spermatic cord also become so painful that the 
weight of the testes gives intolerable pain ; and 
pain is experienced in the back and loins. Not- 
withstanding these symptoms, the testes are not 

* London Hospital Reports, vol. i., p. 77. 
f Lancet, March 31, 1866. 

\ Observations on the Structure and Diseases of the Tes- 
tis. — Chapter iv. London: 1830. 



62 SPERMATORRHEA. 

hot and inflamed; the swelling is paroxysmal, 
and is not accompanied by fever. The general 
health is much impaired, partly in consequence 
of the suffering endured, and partly by reason of 
the disturbance of the nervous and digestive sys- 
tems. The patient has a poor appetite ; he suf- 
fers from indigestion ; he is hysterical and de- 
spondent, and is unable to sleep. Impotence 
is a usual attendant on this state. Tenereal ex- 
cesses, masturbation, and spermatorrhoea, are the 
causes. At least we have frequently obseiwed 
it to accompany spermatorrhoea, and in this case 
it proved the most troublesome and distress- 
ing symptom. The following case very well 
illustrates the signs and symptoms of this mal- 
ady occurring in connection with seminal trou- 
ble. 

Case V. — An Israelite, a?t. 25, was admitted 
to St. John's Hospital, under the following cir- 
cumstances : He had been married a week, but 
proved unable to consummate the sexual act, in 
consequence of which he was placed by bis 
Meads in a hospital to undergo treatment. He 
presented these symptoms: He .was pale and 



RESULTS. 63 

sallow ; his tongue coated ; his appetite was 
poor ; lie had much abdominal pain, especially 
about the umbilicus, and he was constipated. 
The testes were very tender, constantly painful, 
especially when pendent, and the cord was also 
painful. The testes were subject to periodical 
attacks of enlargement, which lasted a few days 
and then subsided, there being, however, no 
redness nor increased heat, but only increased 
tenderness. He experienced various nervous 
symptoms ; among others he had a well-marked 
globus hystericus, and he shed tears on the least 
provocation. He admitted to very great sexual 
indulgences for several years, which were fol- 
lowed by spermatorrhoea. Since the occur- 
rence of irritability of the testes, he had been 
entirely without sexual desire. He admitted 
that he had not been able to effect the sexual 
congress since his marriage.* 

Even when it does not result in impotence, 
hyperaesthesia of the spermatic plexus produces 

* This patient left the hospital after a stay of four weeks. 
He visited me recently, to assure me that he was restored 
to sexual soundness. 



64 SPERMATORRHOEA. 

distressing nervous symptoms of an hysterical 
character. The various pelvic pains, occurring 
in spermatorrhoea, and referred to the prostate, 
neck of the bladder, rectum, perineum, and 
testes, are probably due to the same cause. 



SPEEMATOKRHCEA AS A SYMPTOM. 65 

II. 

SPERMATORRHEA AS A SYMPTOM. 

Various disorders of the nervous system, ac- 
companied by frequent spermal losses, were, 
formerly, confounded with the results of sem- 
inal weakness. This was especially the case 
with the disease known as tabes dorsalis, which 
in the time of Hippocrates was assumed to be 
caused by venereal excesses. In the work De 
Morbis* occurs the following passage : 

Tabes dorsalis a spinali medulla oritur, max- 
ime vero recentes sponsos et libidinosos corripit. 
Febris sunt expertes, bene comedunt, et colliquan- 
tur. Quod si ita affectum perconteris, dicet, sibi 
videri ex superioribus partibus a capite velut for- 
micas in spinam descendere ; quumque urinam 
aut stercus recldit, ipse semen genitale copiosum 
et liquidum prodit ; necque genitura intus concipi- 
tur et inter dormiendum cum uxore dormiat, nee 
ne semen prof undat, etc. (Lib. ii., cap. 19.) 

* Dr. Adams, the learned author of the Sydenham Soci- 
ety's edition of the works of Hippocrates, thinks the book 
De Morbis emanated from the Cnidian school. 



66 SPERMATORRHOEA. 

Celsus also alludes to similar effects produced 
by nimia profusio seminis which tabe hominem 
consumat* 

Under the "same designation similar effects 
have, since the time of Hippocrates, been as- 
cribed to masturbation and venereal excesses 
by various German, French, and English writ- 
ers. By Romberg, t however, the term " tabes 
dorsalis" is restricted to a nervous disease, 
identical with the progressive locomotor ataxia 
of Duchenne. On the other hand, so recent an 
authority as Dr. MeryonJ adheres to the an- 
cient idea of tabes dorsalis, defining it as a 
"tractable form of paralysis, not unfrequently 
seen in youth and early manhood, which may 
be traced to the vicious and enervating habit 
of masturbation." 

In progressive locomotor ataxia there occurs 
a peculiar degeneration of the posterior columns 
of the cord : a gelatiniform degeneration of the 

* De Medicina, lib. iv. , p. 187. Edit. Milligan, Edinburgh : 
1831. 

f A Manual of the Nervous Diseases of Man. Edition of 
Syd. Society, translated by Sieveking, vol. ii., p. 395. 

\ Practical and Pathological Eesearches on the Various 
Forms of Paralysis, p. 44. London : 1864. 



SPERMATORRHEA AS A SYMPTOM. 67 

nerve fibres and a hyperplasia of the interven- 
ing connective tissue. " Progressive abolition 
of co-ordination of movements and apparent 
paralysis, contrasting with integrity of the mus- 
cular force, are the fundamental characteris- 
tics," says Duchenne,* of this disease. Accord- 
ing to this author, it is divisible as respects its 
symptomatology into three periods : 

" 1. Characterized by three symptoms — paios, 
ocular troubles, and anaphrodisia ; 2d, by dis- 
orders of motility and of sensibility in the infe- 
rior extremities ; 3d, the extension of the same 
symptoms to the upper extremities." Before 
anaphrodisia and the disorders of voluntary 
movement, symptoms referable to the genera- 
tive organs are present. These symptoms are 
satyriasis and spermatorrhoea. In fi.Ye cases 
of progressive locomotor ataxia, of which I 
have preserved full notes, more or less decided 
increase of the sexual appetite occurred in the 
inception of the disorder. Involuntary seminal 
losses are observed at the same time, and they 
attract the attention of the patient more than 

* De FElectrisation Localisee, etc. Deux. ed. Paris : 
1861, p. 547. 



68 SPERMATORRHOEA. 

any other symptom then present. It is in con- 
sequence of this fact that progressive locomotor 
ataxia was so long confounded with the results 
of excesses in venery. Trousseau* has espe- 
cially called attention to these sexual symptoms 
which attend upon the first stage of this singu- 
lar affection. 

In some observations on this topic, Topi- 
nardf thus speaks of the symptoms in progres- 
sive locomotor ataxia, belonging to the gene- 
rative organs : 

" Four symptoms present themselves : sper- 
matorrhoea, satyriasis, anaphrodisia, and impo- 
tence. The first occurs amongst the most 
remote antecedents of the first period, through- 
out which it continues. The nocturnal pollu- 
tions, at first accompanied by erections and a 
sensation of pleasure, at last become passive. 
After the spermatorrhoea, or without having 
been preceded by it, there occur, after some 

* Clinique Medicale de l'Hotel Dieu de Paris. Tome 
Deux., p. 534, et seq. 

f De l'Ataxie Locomotrice et en particulier de la Maladie 
appelee Ataxie Locomotrice Progressive. Paris, 1864, p. 
171. 



SPERMATORRHOEA AS A SYMPTOM. 69 

months or years, progressive diminution of 
desire, difficulty in procuring satisfaction, and 
at last absolute impotence." 

Eisenmann reports a case (Topinard), in 
which priapism existed thirty years. " During 
thirty years of his life, priapism had tormented 
this patient, and was only calmed by continual- 
ly increasing and enormous doses of opium." 

In order to exhibit the relation of the genital 
symptoms to the other phenomena in cases of 
progressive locomotor ataxia, I subjoin an 
analysis of the symptoms of the first period in 
the five cases of which I have preserved notes : 

The disease commenced in No. 1, at 35. He 
is 5 feet 6 in. in height ; has a light complexion, 
light auburn hair, blue eyes, and the lymphatic 
temperament. The first symptoms manifested 
themselves in No. 2, at 40 years of age ; he is 
now 65. He is 5 feet 8 in. in height, of nervous 
temperament ; has blue eyes, and his hair, now 
gray, was originally auburn. No. 3 experienced 
the first symptoms at 43 ; he is now 46. He 
has also a fair complexion, blue eyes, and light 
auburn hair. No. 4 was 42 years of age when 
he began to experience the pains ; he is now 45. 



70 SPERMATORRHOEA. 

He is 5 feet 10 in. in height, and has a dark 
complexion, dark eyes, and black hair. No. 5 
experienced his first symptoms at 37, ten years 
ago. He has reddish hair and beard, blue 
eyes, and a strongly marked nervous tempera- 
ment. 

No. 1 had satyriasis, spermatorrhoea, tingling 
and numbness of the feet and legs, and amau- 
rosis and double vision. The satyriasis was 
soon succeeded by anaphrodisia and impotence. 
The dimness of vision and the double vision 
suddenly disappeared at the commencement of 
the second period. He did not experience 
those peculiar pains so commonly present in this 
disease. The whole duration of the first period, 
commencing with the satyriasis, was only three 
months. The symptoms of the first period in 
No. 2 were similar in character, but extended 
over a much longer period. The state of the 
sexual appetite in the beginning could not be 
accurately ascertained, but anaphrodisia soon 
occurred, and absolute impotence was the final 
result. Yiolent pains, supposed to be rheu- 
matic, preceded the other symptoms. These 
pains are localized in the inferior extremities, 



SPERMATORRHOEA AS A SYMPTOM. 71 

and especially in the left hip, so that disease of 
this articulation was suspected. No derange- 
ment of vision occurred at any period. No. 3 
experienced, for more than a year, sharp pains 
in the extremities, and also deep-seated pains 
in the trunk, before the ataxia manifested itself. 
These pains, being sudden in onset, fugitive in 
character, and irregular in their recurrence, 
were supposed to be neuralgia. A decided de- 
crease in sexual desire, and imperfect sexual 
congress were observed, but complete anaphro- 
disia did not occur. Dimness of sight, but no 
other ocular trouble, has thus far been present 
in this case. In No. 4, two years of neuralgic 
pains preceded the other symptoms. The pains 
had the two characters so frequently noticed in 
this disease : the first, deep-seated, dull, and 
heavy, pretty nearly constant ; the second, 
sharp and sudden, temporary. The dull and 
heavy pains experienced in the lumbar region, 
in the thighs, and in certain parts of the 
trunk, preceded the others, which attacked the 
legs and thighs. No ocular derangemeut oc- 
curred, in this case. Spermatorrhoea, anaphro- 
disia, and impotence, however, were experienced 



72 SPERMATORRHEA. 

early. No. 5 began to have pains in the lum- 
bar region in 1857, and soon after severe at- 
tacks of neuralgia along the course of the 
sciatic. These were succeeded by sharp, sud- 
den, and fugitive pains in both inferior extrem- 
ities. 

The patient compares these pains to electric 
shocks. Anaphrodisia and spermatorrhoea did 
not occur until two years after the pains had 
been experienced. He admits that at the pres- 
ent time he is completely impotent. Derange- 
ments of vision manifested themselves in two 
years after the commencement of his malady. 
These consisted in amblyopia and double vision. 
They disappeared suddenly — in a night, he says 
— after continuing for several months. 

After the first period has passed there can be 
no difficulty in coming to a conclusion as to the 
relation of the spermatorrhoea to the other phe- 
nomena. 

Various other affections of the nervous system 
are accompanied by involuntary seminal losses. 
Diseases of the medulla, cerebellum and pons, of 
the spinal cord, epilepsy, chronic mania, may 
have this as a more or less pronounced symptom. 



SPERMATORRHOEA AS A SYMPTOM. 73 

In the early stage of diabetes, before impotence 
results, spermatorrhoea is sometimes present. 

In all cases in which the involuntary loss is a 
symptom merely, it is of little consequence from 
the therapeutical point of view ; the centric 
lesion, of which it is a sign, is the point of 
importance to which our attention should be 
directed. 

That the spermatorrhoea is a symptom merely, 
should be easily determined by reference to the 
accompanying lesions. There will be present 
evidences of degenerative changes in the great 
vessels, in the fundus oculi, in the organs of special 
sense, and in the cerebro-spinal centres. As a 
rule, spermatorrhoea as a substantive affection 
occurs in the young, in men at the most vigorous 
period of life, and is a result of the abuse of 
the sexual organs. On the other hand, sperma- 
torrhoea as a symptom appears after the middle 
period of life, during the decline of sexual 
activity, and coincidentally with symptoms 
indicating lesions of the cerebro-spinal appara- 
tus. "When spermatorrhoea is a symptom, the 
important centric lesions on which it depends, 
soon manifest themselves by other and more 



74 SPERMATORRHOEA. 

characteristic signs ; whereas when spermator- 
rhoea is a disease, the case remains in very much 
the same state months, even years. Attention 
to these points can hardly fail to conduct the 
examination to a correct conclusion. 



IMAGINARY SPERMATORRHEA. 75 

III. 

IMAGINARY SPERMATORRHEA. 

It is important to bear in mind that involun- 
tary seminal losses, to constitute a disease, should 
occur with sufficient frequency to produce defi- 
nite symptoms. Many patients who come to a 
physician for advice and treatment for this affec- 
tion, are not really suffering from the seminal 
losses, but from an imaginary ailment. Ex- 
periencing an occasional seminal loss, and igno- 
rant in regard to the physiological condition, 
they imagine themselves the subjects of sperma- 
torrhoea. Brooding over their presumed "weak- 
ness," they fall into a hypochondriacal state, and 
soon experience the whole train of wretched 
symptoms depicted in popular works on the 
subject. Every subjective sensation, no matter 
what its origin, is referred to the debilitating 
effects of the spermal losses. As an evidence of 
the attention which these patients give to their 
sensations, and of their mental and moral 
peculiarities, I subjoin a written statement 
handed to me by one of them, on presenting 
himself at my consultation-rooms : 



76 SPERMATORRHEA. 

" Kinging in my ears occasionally. 

"Fullness and weight in stomach at all times. 

" Considerable wind in the stomach. 

" Want of strength in thighs and groins. 

"Dull, heavy feeling in back of head at night 
and after dinner. 

" Drowsiness after supper, so that I cannot 
read. 

" Great want of clearness and want of strength 
of vision. 

" Weakness of voice, and sometimes thickness 
of speech. 

" Very sensitive to the least rudeness, and very 
apt to become nervous and low-spirited from 
being harassed or worried in any way. 

" Heart palpitates somewhat violently at times. 

" Digestion is very imperfect. 

" Dryness of the scalp. 

" Have been very subject to having boils on 
my legs, which always were of a dry nature. 

"Apt to have pimples on forehead and neck." 

All of these symptoms he referred to seminal 
emissions, occurring at intervals of three weeks. 
His health was robust, and he was actively en- 
gaged in business ; but the corners of his mouth 



IMAGINARY SPERMATORRHOEA. 77 

were depressed, and his countenance had an air 
of deep dejection. 

Cases of this kind are very numerous, and 
difficult to manage. No explanation or demon- 
stration satisfies them. One apprehension al- 
layed, they quickly take up another, returning at 
last to the sexual disorder. They exhibit a real 
pleasure in dwelling upon this infirmity, and in 
talking with endless iteration over all the dis- 
gusting details connected with it. 

Certain masturbators, struggling to free them- 
selves from the trammels of the vice, but too 
weak of will to resist it wholly, please themselves 
with the delusion that the act is involuntary, 
because it is indulged in during the dreamy con- 
sciousness of the half-waking state. They con- 
sult the physician under the guise of having 
involuntary evacuations. 



78 SPERMATORRHEA. 

IV. 

TREATMENT. 

A correct view of the pathology of sperma- 
torrhoea is necessary to its successful curative 
treatment. 

If spermatorrhoea be a purely local disease — an 
inflammation and ulceration of the prostatic por- 
tion of the urethra — local treatment only will be 
required. If, however, the essential condition 
consists of an increased reflex excitability of the 
spinal cord, due to frequent peripheral irrita- 
tion seated in the urethra, then the local must be 
regarded as accessory to the general treatment. 
The relative importance of these two views as to 
the causation of the disease, should be definitely 
ascertained. A particular plan of treatment is 
followed by the adherents of each view. A wise 
therapeutist will not reject whatever is beneficial 
in either plan. 

The local treatment consists in the applica- 
tion of the porte caustique to the prostatic portion 
of the urethra ; the use of injections of the nitrate 
of silver, sulphate of copper, acetate of lead, etc. ; 



TREATMENT. 79 

certain mechanical expedients ; the internal ad- 
ministration of copaiba, cubebs, and other reme- 
dies of this class ; cold hip -bathing, and injec- 
tions of cold water into the rectum, etc. The 
most important of these measures is the use of 
the porte caustique. This instrument has been 
largely employed since its introduction for this 
purpose. Few practical surgeons at the present 
day will assent to the dictum of Lallemand, that 
" two-thirds of the cases of spermatorrhoea would 
be beyond the reach of medical assistance, if it 
were not for the good effects produced by the ap- 
plication of the nitrate of silver to the prostatic 
portion of the urethra." 

It is very desirable, however, to ascertain its 
real importance and the limits of its applica- 
tion. 

The Porte Caustique. — This instrument, which 
is so closely associated with the name of Lalle- 
mand, had an existence long anterior to his 
employment of it. Ambrose Pare devised an 
instrument for cauterizing the urethra, which is 
the progenitor of the modern instruments for 
this purpose. It consisted of a silver canula 
and a stylet of the same metal, having at its 



80 SPERMATORRHOEA. 

extremity a tampon of linen which was dusted 
with powdered caustic. Loizeau is said to have 
cured King Henry IV. of France of an induration 
of the urethra (organic stricture) with a similar 
instrument. Wiseman of England, and after- 
wards Hunter, employed the nitrate of silver in 
a porte caustique, but the latter substituted a 
caustique holder for the linen tampon. Sir 
Everard Home * was a warm advocate for the 
proceeding of Hunter. The instrument of Du- 
camp was the more immediate progenitor of 
Lallemand's. It was a porte caustique com- 
posed of a gum elastic canula the stylet being 
an ordinary bougie, and of a caustic holder of 
platinum which was attached to the bougie. 
Amussat t in 1824 also invented a porte caus- 
tique, the canula being of silver, and the stylet, 
of the same metal, contained at its extremity a 
platinum point for lodging the caustic. About 
the same time Lallemand proposed his instru- 



* Practical Observations on the Treatment of Strictures 
of the Urethra and Esophagus. Second Edition. London : 
1797. P. 116, et seq. 

f Legons du Amussat, sur les retentions d' urine, etc. 
Paris : 1831, p. 115, et seq., from which many of these par- 
ticulars have been obtained. 



TREATMENT. 81 

mcnt, and a discussion arose as to the value 
of each instrument respectively. Differing in 
merely mechanical arrangements, the object to 
be attained in the use of them was essentially 
the same. The application of the caustic was 
employed in cases of thickening of the canal, 
ulceration and stricture due to chronic inflam- 
mation. We find in Lallemand's treatise on the 
disease of the genito-urinary organs,* the germ 
of those ideas put forth in full maturity fifteen 
years later in his work Des pertes seminales in- 
voluntaires. After a discussion of the changes 
produced by blennorrhagia, he proceeds as 
follows : 

" It may be easily conceived that irritation 
of the mucous membrane of the prostatic por- 
tion may extend itself to the ejaculatory canals, 
the vesiculse seminales, etc. ; and the proof is, 
the engorgement of the testicle which so fre- 
quently accompanies stricture. The results of 
this irritation of the seminal reservoirs and 
ejaculatory ducts are, that the act of coitus is 
promptly followed by the ejaculation ; that the 

* Observations sur les Maladies des Organes Oeniio- 
urinaires, Premiere Partie. Paris : 1825, p. 158. 



82 SPERMATORRHOEA. 

patients have frequent nocturnal pollutions, 
and that in some cases the voluptuous sensa- 
tion is accompanied by a more or less acute 
pain. Still further, the irritation augmenting, 
the seminal emission takes place with an in- 
complete erection, or is expelled with the last 

drops of urine 

Governed by analogy and by direct experiences, 
I have not hesitated to apply to these parts the 
nitrate of silver ; the mucous membrane takes 
on a new action ; a benign inflammation sup- 
plants the chronic inflammation ; tone is re- 
stored to the tissues, and the mucous secretion 
progressively diminishes." The original idea 
of Lallemand, following Pare, Hunter, Ducamp, 
and others, was the treatment of these chronic 
inflammatory affections of the urethra resulting 
in stricture, ulceration, and abscess. The ex- 
tension of the method of cauterization to the 
treatment of spermatorrhoea was an after- 
thought. Very diverse views have obtained 
since as to the utility of the porte caustique. It 
has not, in general, produced that favorable 
impression upon these cases claimed for it by 
its advocates. Not only does it often fail to 



TREATMENT. 83 

cure the patient, but the application of the 
caustic is frequently followed by most serious 
consequences.* In all cases it produces great 
irritation, frequently strangury and bloody 
mine, and sometimes severe urethritis and cys- 
titis. Too long contact of the caustic may in- 
duce induration and organic stricture, a very 
serious complication of the case. Notwith- 
standing these sometimes unfortunate results, 
some surgeons adhere to it, and a few claim all 
that Ducamp, or Amussat, or Hunter, or Home, 
did in former times. Mr. Acton, for instance, 
is a zealous partisan of the porte caustique, 
contending [p. 225] that, as far as his own ex- 
perience is concerned, it " fully bears out " the 
statement of Lallemand as to the infrequency 
of any ill consequences arising from its use. 
"We should not, therefore, reject this practice of 
cauterization entirely. Under what circum- 
stances may we resort to it? There appear to 
be two classes of cases in which it is indicated : 
1st. Those in which chronic inflammatory 



* Thompson, On Enlarged Prostate : Its Pathology and 
Treatment, etc. Op. cit. 



84 SPERMATORRHOEA. 

changes exist as a complication of spermator- 
rhoea. 

2d. Those in which the moral effect of the 
application is desirable. 

We have already, we think, conclusively es- 
tablished that the lesions of the prostatic por- 
tion of the urethra, described by Lallemand as 
constant to spermatorrhoea, are only accidental. 
The\^ are produced by inflammation arising in 
the course of gonorrhoea, as appears evident 
enough indeed, on the perusal of the cases 
given by Lallemand in his treatise on diseases 
of the urinary organs. At all events, it is not 
at all common to find such changes in the 
urethra of patients suffering from seminal 
weakness in this country. A hypersesthetic 
state of the canal, especially of the prostatic 
part, is, on the other hand, a most usual condi- 
tion. 

Eomburg * has very well indicated the cases 
of the second class to which the use of the 
porte caustique is adapted : " Spermatorrhoea, 
to which not unfrequently hypochondriasis is 

* Manual of the Xervous Diseases of Man. Op. cit. Vol. 
i., p. 188. 



TREATMENT. 85 

to be attributed, requires special attention, and 
if all other remedies fail, we must have re- 
course to cauterization of the urethra, which 
has a moral as well as a physical effect by 
withdrawing the patient's attention from his 
malady." It is not improbable that to this 
" moral effect " is to be attributed much of 
whatever good is accomplished by the use of 
the porte caustique. 

We would limit the application of caustic, 
then, to those conditions of inflammation, ulcer- 
ation, and hyperesthesia of the prostatic por- 
tion of the urethra, which proved refractory to 
other less painful and dangerous methods. For 
the moral effect, we would limit it to those ob- 
stinate cases accompanied with severe hypo- 
chondria, in which the fancy of the patient 
referred all the suffering to the region of the 
prostate, and to the cases of youths who perse- 
vered in the vice of masturbation. 

The use of the porte caustique is not attended 
with difficulty. Certain precautions, however, 
are requisite to avoid injury to the parts. In 
the first place, it is necessary to ascertain the 
length of the canal, which may be done by in- 



86 SPERMATORRHOEA. 

troducing the catheter and observing the mo- 
ment it enters the bladder. The length of the 
urethra from the meatus to the bladder is then 
marked on the canula. The curette is now 
charged with melted nitrate of silver and placed 
in the canula, which is oiled and introduced the 
desired length. The operator, however, will 
perceive when he enters the sphincter of the 
bladder bj the sensation of the passage of the 
enlarged extremity of the instrument. Now 
when this enlarged extremity is withdrawn 
through the sphincter the sensation will be 
quite distinct, and the operator will know that 
he is in the prostatic part. It is only necessary 
to withdraw the outer canula half an inch and 
rotate rapidly the curette, withdrawing it quick- 
ly into the canula. Before the operation is per- 
formed the patient should empty the bladder, 
and he should not make water for some hours 
afterwards. The recumbent position should be 
enjoined, diluents and alkalies prescribed, and 
a moderate diet directed. Should there be 
much pain, opiates, morphia, or chlorodyne may 
be prescribed, or an anodyne suppository, or 
an enema of starch and laudanum may be in- 



TEEATMENT. 87 

troduced. For several clays afterwards consider- 
able irritation is experienced, even when most 
care has been exercised. 

Injections. — If cauterization be desirable, it 
may be accomplished by injection. This is cer- 
tainly as effectual and much safer than the pre- 
ceding operation. A special instrument, such as 
Mr. Acton's glass syringe, may be employed, or 
the universal syringe (Fig. 3), which may be 
fitted to a silver catheter, will suffice for the 
purpose. The catheter must be introduced into 
the bladder, and then withdrawn into the pros- 
tatic portion of the urethra. The solution of 
nitrate of silver, of sulphate of copper, of ace- 
tate of lead, or, preferably, of tanno-glycerine 
(3 j. — I j.), may now be injected and allowed to 
apply itself thoroughly to the mucous surface. 
Not more than 3 j of the solution should be 
used at a time, and too great force should be 
avoided lest the fluid be thrown into the blad- 
der. The strength of the nitrate of silver solu- 
tion should not exceed gr. x. — f j. Before the 
injection is made the patient should be required 
to empty the bladder, and should avoid emission 
of urine after as long as possible. Injections 
7 



SPERMATORRHOEA. 




TREATMENT. 89 

by an ordinary penis syringe are sometimes 
recommended, but they are entirely futile. It 
is difficult, if not impossible, to make efficient 
application in tins way to the prostatic part of 
the urethra. 

A great many instruments have been devised 
for making application to the prostatic part of 
the urethra. It would be a waste of space to 
mention them all. The universal syringe and 
catheter answer most purposes. I have had 
constructed, in ' imitation of many that have 
been devised, a syringe which is very useful for 
this purpose. It consists of an ordinary hard- 
rubber syringe, having a nozzle the diameter of 
a No. 6 catheter, and seven inches in length. 
The nozzle terminates by an olive-shaped blind 
extremit} T , behind which are a number of orifices 
for the escape of fluid. (Fig. 4.) The injected 
fluid flows from within outward, and is pre- 
vented by the bulb in front from escaping into 
the bladder. 

Catheterism is beneficial in that state of hy- 
peresthesia of the prostatic part of the urethra 
which is so commonly present in cases of sper- 
matorrhoea. The mere stretching of the canal 



90 SPERMATORRHOEA. 

by a full-sized bougie or catheter has the ef- 
fect to diminish the excessive sensibility of the 
parts, and the moral effect of the introduction 
of the instrument is not inconsiderable. 

The application of cold by means of a con- 
tinuous flow of hydrant water, is an expedient 
which sometimes allays irritation of the prosta- 
tic part most admirably. The apparatus re- 
quired, consists of a double canula curved in 
catheter-shape, and having orifices of entrance 
and exit at the external extremity, the internal 
or bladder extremity being closed ; rubber tub- 
ing of sufficient length. A tube is attached to 
the water tap and to one orifice of the canula 
which is so introduced that it reaches to and 
through, the prostatic part. Another tube com- 
municates with a receiving vessel. When water 
is turned on a continuous stream flows through 
the canula. Instead of communicating with the 
hydrant, the supply of water may be by gravity. 

Circumcision. — When the prepuce is long the 
glans penis is kept moist and the epithelial layer 
becomes exceedingly delicate and susceptible. 
The abundant sensitive nerves of the glans are 
thus placed in the most favorable condition for 



TKEATMENT. 91 

the reception of impressions; an irritation ex- 
perienced there is promptly, and with height- 
ened impulse, conveyed to the cord, and hence, 
in the act of coitus, the emission takes place 
too quickly. So too, in sleep, the venereal im- 
pulse takes its origin, frequently, in these nerves 
thus endowed with an exaggerated sensibility. 
For these reasons, the operation of circumci- 
sion is frequently necessary in the treatment of 
spermatorrhoea. It would, probably, be well 
for society if the Jewish rite were made univer- 
sal. It is a well-known fact, that, although the 
Jews suffer from gonorrhoea, they are rarely 
affected with syphilis. My observation justifies 
me in asserting that it is uncommon to meet a 
Jew afflicted with " seminal weakness." The 
freedom with which they expose themselves 
to contagion, and their great sexual activity, 
would, certainly, favor the occurrence of these 
disorders, if circumcision did not prove a pro- 
tection. A knowledge of this hygienic fact, 
probably, existed at a very remote period of 
antiquity, for, according to Herodotus,* the 

* Vol. ii., chap. 37, p. 53. 



92 SPERMATORRHEA. 

Egyptian priests " practised circumcision for 
cleanliness, considering it better to be cleanly 
than comely." The editor of Herodotus in a 
foot-note expresses the belief that " this insti- 
tution reaches to the most remote antiquity ; we 
find it existing more than 2,400 years before 
our era, and there is no reason to doubt that it 
dated still earlier." At first confined to the 
priests, it afterwards extended through all ranks 
of society, as the benefits of the practice be- 
came known. In all probability the Jews ob- 
tained it from the Egyptians. 

Other instrumental methods. — We may classify 
under this head various mechanical appliances 
to prevent involuntary seminal discharges. A 
useful expedient of this kind is a leather ring 
armed with metallic points large enough to be 
worn without discomfort until erection occurs, 
when the pricking will arouse the patient. This 
instrument may be employed by those who 
have decided erections and the emission with a 
distinct orgasm. Trousseau * recommends the 
introduction of a pear-shaped cylinder of wood 

* Clinique Medicale de V 'Hotel Dieu, etc., op. cit., vol. ii., 
p. 646-8. 



TREATMENT. 93 

into the rectum to compress the prostate and 
seminal ducts. This barbarous contrivance, as 
it seems to me, cannot prevent venereal excite- 
ment and erection, although it may prevent 
emission, or force the semen backward into the 
bladder. Trousseau, however, speaks warmly 
in its praise, and adduces evidences of the good 
effects of the practice. Any theoretical objec- 
tion which we may entertain must yield to the 
demonstrations of clinical observation. Accord- 
ingly, I will, when a suitable case presents it- 
self, give this method of treatment a fair trial. 
Meanwhile, having no experience of its use to 
narrate, we propose to put our readers in pos- 
session of the experience of M. Trousseau. 
He observes that this apparatus has been of 
real service, and that more than one case, re- 
bellious under all methods of treatment, yielded 
completely and promptly to this means. He 
alludes especially to the rapid return of the 
virile power in the cases treated in this way. 

In the same category may be classed the 
method of acupuncture. This consists in pass- 
ing long needles into the prostate, vesiculae 
seminales, and sometimes into the testes and 



94 SPERMATORRHEA. 

vasa deferentia. Lallemand thinks it unfortu- 
nate that acupuncture has fallen into disuse ! 
We can hardly join in his regrets. A general 
objection may be urged against all of those 
mechanical appliances that they fix the atten- 
tion of the patient upon his infirmity, thereby 
retarding recovery. 

Another remedy, proposed in Trousseau's 
clinical lecture on spermatorrhoea, is forced dila- 
tation of the anus. This practice was recom- 
mended to him by Dr. Adolphe Kichard, who 
operated on a case in Trousseau's presence, 
with a most fortunate result. Four months 
afterwards Dr. Eichard received a letter from 
the young man announcing that the good effects 
continued. The frequent passage of rectal bou- 
gies, increased to the utmost capacity of the 
anus, is, sometimes, very beneficial. 

Since the last edition of this monograph, I 
have had excellent results from stretching the 
sphincter ani. The method as pursued by me 
consists in the introduction of a bi-valve rectal 
speculum, and then working the screw until the 
blades are sufficiently separated. This opera- 
tion causes considerable pain, and may rupture 



TREATMENT. 95 

the sphincters if incautiously carried too far. 
The methodus medendi is not known, nor the 
class of cases to which this method is adapted ; 
but it has seemed most useful in the cases of 
simple spermatorrhoea. 

The internal medicines intended to act locally 
are chiefly copaiba and cubebs. They need 
only be mentioned to be condemned, for the 
irritation which they produce in the mucous 
membrane of the stomach and kidney will more 
than counterbalance any possible good which 
they can accomplish in the urethra. Enemas 
of cold water and other medicaments and sup- 
positories are capable of much more useful re- 
sults. We have found urethral suppositories, 
especially, of great utility in those cases of so- 
called " diurnal pollutions," which consist essen- 
tially of urethral leucorrhcea. 

The medical treatment has consisted in the 
main in efforts to improve the general health 
by appropriate tonics, as iron, quinine, strych- 
nia, sea-bathing, douches, etc. ; by suitable di- 
etetics ; by improved hygiene, etc. Conjoined 
with these measures anaphrodisiacs are em- 
ployed as they seem to be indicated. 



96 speematoeehcea. 

Remedies employed in the Treatment of - 
Speematoeehcea. — It will be convenient to dis- 
cuss under this head the actions and uses of 
the most approved remedies. 

Anaphrodisiacs. — One of the oldest of these 
remedies is camphor. Camphora per naves cas- 
trat odore mares, was an aphorism of the school 
of Salernum. It is not, however, a very valu- 
able remedy. To produce the desired anaphro- 
disiac effect large doses are necessary ; it fre- 
quently fails, and its action upon the stomach 
is unpleasant, giving rise to a sense of heat and 
burning, and followed by disagreeable eructa- 
tions. 

Lupulin is much employed by many distin- 
guished therapeutists. Thus it is a favorite 
remedy with Lebert,* who gives it in combina- 
tion with camphor. It has considerable efficacy 
as an anaphrodisiac, but, like camphor, it is 
uncertain. Belladonna, or better its alkaloid, 
atropia, is much more efficient than camphor. 
Our indigenous remedy, gelsemium, is still more 
powerful in its action on the sexual organs. 

* Op. cit. , vol. ii.,p. 587. 



TREATMENT. 97 

The fluid extract of either of these agents may 
be combined with other anaphrodisiacs, or they 
may be given alone. The tincture of belladon- 
na and the tincture of gelsemium may be pre- 
scribed with advantage together. 

The most important agent of this class, the 
most efficient and certain, and the least dis- 
tressing in its immediate and remote effects, 
when freely administered, is the bromide of 
potassium. The anaphrodisiac property of this 
drug is now almost universally acknowledged, 
but the conditions of its success and failure 
have not been as definitely determined as is 
desirable. There are yet seme sceptics who 
disbelieve in this property of the bromide of 
potassium. One of the most recent and preten- 
tious of them is Dr. S. W. Duckworth Wil- 
liams.* The cases submitted by him in proof 
of his "views serve very well to illustrate the 
conditions under which the bromide of potas- 
sium fails, to produce its characteristic effects. 
We accordingly reproduce them in Dr. Wil- 

! * On the Efficacy of the Bromide of Potassium in Epilepsy 
and certain Psychical Affections. Churchill, London, I860 
(Pamphlet.) 



98 SPERMATORRHEA. 

Harris's words, as they are very suitable to our 
purpose. " Dr. Crichton Browne, in a pamphlet 
on 'The Action of the Bromide of Potassium 
upon the Nervous System,' published since I 
commenced writing these remarks, is very much 
inclined to allow it strong anaphrodisiac pro- 
perties, although I cannot quite perceive on 
what data. He owns that he had had no op- 
portunity of trying the bromide of potassium 
in simple nymphomania, although he used it 
without effect in one patient who was in a state 
of mania, following upon melancholia, and in 
whom there was presumed to be excitement of 
the sexual feelings, on account of the extra- 
ordinary obscenity of language which she used. 
Now, I have tried it in every variety of uterine 
affection that has come within my reach, in- 
cluding nymphomania, satyriasis, menorrhagia, 
amenorrhoea, dysmenorrhcea, etc., etc., but with- 
out perceiving the least benefit accrue. . . . 
I had under treatment at one time two cases 
that seemed especially well adapted for favor- 
ing the anaphrodisiac properties of this medi- 
cine. They were both strong, healthy girls, the 
one a lady, the other a domestic servant. Both 



TREATMENT. 99 

were admitted into the asylum at Northampton, 
suffering from simple mania without any posi- 
tive delusion. They were lively, excitable, rest- 
less, and extremely volatile, often able to com- 
mand their faculties sufficiently to converse 
calmly and rationally for a few minutes on any 
ordinary subject, but liable at any moment to 
burst out laughing or into a fit of tears without 
any visible cause, or to begin to rave and 
scream, or swear ; both were fine, handsome, 
fully developed young women ; both were most 
indecent in language, voice, and gesture, and 
both openly practised self -pollution. The bro- 
mide of potassium was given to them in doses 
of gr. v. bis die in a little pure water, and in- 
creased up to gr. xx., and although both were 
much affected by its use, and both became pale 
and thin, and reduced, and their circulation 
powerfully controlled (indeed, in one case the 
pulsations were reduced from 90 to 60 beats 
in a minute), nevertheless they persisted in their 
bad habits, and their sensuality became, if pos- 
sible, more confirmed. The administration of 
the medicine was persisted in for nearly twelve 
months in both cases. 



100 SPERMATORRHEA. 

" Another case in which I tried it was that of 
a married lady, nearly 40 years of age, in a state 
of chronic mania, and at the same time I made 
some observations as to the influence of the 
bromide on the heart's action. This lady was 
extremely amative, fell in love with every per- 
son of the opposite sex she encountered, and 
was in the habit of writing the most obscene 
letters to all her male acquaintances. Her 
pulse was habitually about 90 — tolerably strong 
and full. Being of a strong constitution, I com- 
menced by giving gr. xv. his die. About an 
hour after the third dose her pulse was 76 ; two 
hours from that time it had almost regained its 
accustomed frequency, but in an hour's time 
from the fourth dose it was reduced to 70, and 
on one occasion during the first week it was 
nearly as low as 60. Combined with this de- 
crease in the circulation there was, as might be 
expected, marked languor and ennui almost 
amounting to debility, and she seemed inclined 
to maintain the recumbent position constantly ; 
but I cannot say that her lascivious wishes or 
ideas were in the least disturbed, or that her 
advances were marked by more delicacy; au 



TREATMENT. 101 

oontraire, I am not quite sure that she was not 
worse." 

The experience of Dr. "Williams, which seems 
so entirely opposed to that of other observers, 
is easily interpreted by a knowledge of the con- 
ditions which retard or altogether prevent the 
action of the bromide of potassium. In some 
investigations, published recently,* I attempted 
to define these conditions. My conclusions 
were embodied in the following : 

" Its physiological effects are not very de- 
cided, and are readily modified by any local 
disturbance. 

"Its therapeutical action is still more decid- 
edly influenced by local morbid processes. 

"It is indicated where a sedative to the 
nervous system is required, e. g.— in insomnia ; 
too great reflex excitability ; nervous and spas- 
modic affections of the larynx and bronchi; 
sexual excitement, and in an irritable state of 
the sexual organs. 

" It icill he effectual in the foregoing conditions, 
in proportion to the degree in tuhich structural 

* Experimental Investigations into the Actions and Uses 
of the Bromide of Potassium. Cincinnati Lancet and Ob- 
server, 1865. 



102 SPERMATORRHOEA. 

lesions are absent, or in otlver ivords, in propor- 
tion to the degree in ivhich these morbid states are 
functional rather than organic" 

These conclusions, the result of observation 
and experiment, afford us a satisfactory solution 
of the cause of failure in the use of the bromide 
of potassium in cases such as those described 
by Dr. "Williams. The cases of sexual excite- 
ment in mania are due, as is shown by Schroe- 
der van der Kolk, to structural alteration in the 
medulla oblongata, the centre, according to this 
author, of the sexual impulse. The bromide 
of potassium can have no influence over these 
structural alterations, and hence cannot control 
the manifestations of sexual excitement which 
depend upon them. 

Aphrodisiacs. — These are indicated under cer- 
tain circumstances. The tincture of cantha- 
rides is sometimes beneficial in cases of great 
atony and relaxation — those characterized by 
profuse mucous discharge, so-called diurnal 
pollutions, very feeble power of erection, and 
absence of sexual desire. It is contra-indicated 
where much hyperesthesia of the prostatic 
portion of the urethra exists. To prevent its 



TREATMENT. 103 

irritant effects, or at least to reduce them to 
the minimum, opium, or cannabis indica, Or 
chlorodyne, may be advantageously combined 
with it. The red or amorphous phosphorus, or 
phosphide of zinc, may be given in the same 
class of cases as suggested for the tincture of 
cantharides. Nux vomica is adapted to those 
cases in which it is desired to restore the func- 
tional activity of the sexual organs, after the 
state of quiescence induced by the prolonged 
administration of anaphrodisiacs. Cimicifuga 
(actea racemosa) has seemed to me to pos- 
sess considerable aphrodisiac power, and has 
proved useful in cases of long-standing sper- 
matorrhoea accompanied by nervousness and 
anxiety, and diminished sexual desire. 

Jaborandi, or its alkaloid, pilocarpin, is an 
efficient aphrodisiac, and is indicated in cases 
characterized by debility. I have found it more 
efficient than any of the agents referred to — 
more efficient than phosphorus. The dose, 
which is generally sufficient, is thirty minims of 
the fluid extract morning and evening. From 
one-fifteenth to one-eighth of a grain of muriate 
of pilocarpin may be given. 



104 SPERMATORRHOEA. 

Galvanism, especially the induction current, 
and static electricity, are often decidedly aphro- 
disiac, and are probably applicable to more 
numerous cases than any other remedy of the 
class. 

Duchenne * (de Boulogne) operates in the fol- 
lowing manner : One rheophore properly insu- 
lated is introduced into the rectum, and placed 
in contact with the has fond of the bladder ; 
the other is passed to the prostatic part of the 
urethra. In this way a current can be made to 
traverse the vesiculce seminales and ejaculatory 
apparatus. Benedikt f applies " the copper 
pole to the lumbar vertebrae, and passes the zinc 
pole along the spermatic cords, over the differ- 
ent zones, transversely, of the penis, and along 
the perineal region antero-posteriorly. . . Be- 
side this, usually three times in two weeks, the 
copper pole is applied by means of a catheter- 
shaped rheophore to the orifices of the ejacula- 
tory ducts, and the zinc pole is passed along 
the spermatic cords." 

Ergot has been much extolled in those cases 

* De rfilectrisation Localisee. Paris, 1861, p. 97. 
f Elektrotherapie. Wien, 1868, p. 446. 



TREATMENT. 105 

in which emission takes place quickly with feeble 
erections. 

Tonics. — Iron, quinine, the vegetable bitters, 
the mineral acids, are indicated in anaemic cases. 
The hygienica, air, exercise, bathing, travel, etc., 
are valuable adjuncts to the remedial measures. 

The Therapeutical Management oe Sper- 
matorrhoea comprehends — 

First, the treatment of the causes. 
Second, the treatment of the malady. 

The Treatment of the Causes. — We have al- 
ready expressed the opinion that venereal ex- 
cesses, and especially masturbation, are the 
causes of spermatorrhoea, in a vast major- 
ity of cases as they occur in this country. 
Hence it is important to recognize this vice at 
an early period, to prevent the immediate and 
remote consequences of its continued perpetra- 
tion. 

We have already seen that this vice is con- 
tracted chiefly by boys in whom the nervous 
preponderates over the muscular and digestive 
systems, and that certain moral and social 



106 SPEItMATOBRHCEA. 

circumstances, and organic peculiarities, in- 
crease the tendency to it. These influences 
must, as far as possible, be repressed. Of 
course, it is not within the power of the 
physician to alter those inherent mental and 
physical defects which exercise such a bane- 
ful influence ; but much may be done to 
diminish the activity of the nervous sys- 
tem, and to restore the balance between it and 
the other systems. Therefore, to the physical 
culture of boys possessing these inherited pe- 
culiarities too great importance cannot be at- 
tached. The development of the muscular and 
digestive systems should be promoted by every 
agency. Open air exercise, constant physi- 
cal employment, avoidance of confinement and 
idleness, cold bathing, etc., are the means ne- 
cessary for this purpose. Lebert * places chief 
reliance upon these hygienic means in all cases 
of masturbation and spermatorrhoea. The prin- 
cipal organic peculiarity promotive of this vice, 
is phymosis. "Where this condition exists, the 
operation of circumcision is proper. A long 

* Op. cit., p. 784, vol. ii. 



TBEATMENT. 107 

and contracted prepuce hinders the develop- 
ment of the penis, and by retaining the mois- 
ture and secretions of the part, increases the 
sensibility of the glans. 

Ignorance of the character and tendency of 
the habit favors the perpetration of mastur- 
bation. Parents and public teachers have a 
sad duty to perform in this connection which 
they naturally shrink from. In a large major- 
ity of cases the habit would be discontinued, if 
the dreadful consequences of it were plainly set 
forth to the unfortunate victims. This becomes 
especially necessary in boarding schools and 
in other public institutions where numbers of 
boys are congregated. 

It is also very important to prevent sugges- 
tive novels, and books of every description hav- 
ing a tendency to excite erotic ideas, falling 
into the hands of these youths. 

As a general rule it is sufficient in cases of 
masturbation to set forth clearly the dangers of 
the practice ; to institute a thorough system of 
physical culture ; to reduce the mental work; 
to keep the body occupied ; to correct, if possi- 
ble, any organic imperfection which may be 



108 SPERMATORRHOEA. 

remedied (phymosis), in order to effect a cure. 
In some inveterate cases this may not be suffi- 
cient. The habit may be so confirmed, the in- 
stincts so low, and the moral obliquity so great, 
that no means other than physical restraint will 
prevent the perpetration of the act. The me- 
chanical appliances may be assisted by ana- 
phrodisiacs. 

Mr. Heckford * has recently published a 
paper showing the great value of "circumcision 
as a remedial measure in certain forms of epi- 
lepsy, chorea, etc." In the very instructive 
cases given by Mr. Heckford, the convulsive 
affections depended upon masturbation. 

As the operation of circumcision is easily 
performed, and is without danger to life, it 
should not be omitted from the treatment in 
two classes of cases: 1. Those in which the 
habit of masturbation is due to the hyperes- 
thesia of the glans produced by an elongated 
prepuce and the irritation of the retained seba- 
ceous matter ; and 2. In those cases in which 
the same cause (a peripheral irritation) in- 

* London Hospital Reports, 1865, vol. ii., p. 62. Already 
quoted. 



TREATMENT. 109 

duces the venereal orgasm and involuntary dis- 
charge. 

Although we do not deny the possibility of it, 
we regard it as rather improbable that a mere 
peripheral irritation, such as an irritable or in- 
flamed state of the prostatic portion of the 
urethra, or a balanitis, will of itself produce 
the reflex phenomena of spermatorrhoea. Such 
irritation, however, will undoubtedly increase 
the morbid excitability of the reflex faculty, if 
it have already been aroused by such causes as 
masturbation and venereal excesses. 

Ceasing an ill habit may suffice in many cases 
to cure these local irritations. The operation 
of circumcision should be performed when the 
prepuce is long, the glans moist, and epithelium 
very sensitive. The frequent application of 
cold water to the glans, when in this condition, 
is of great service. The tanno-glycerine (3i. — §i.) 
may also be applied daily to the glans with ad- 
vantage. Similar measures" may be adopted for 
an irritation in the prostatic part of the urethra : 
daily injections of cold water ; the injection 
through a silver catheter in the manner already 
recommended, of the tanno-glycerine, or of a 



110 SPERMATOEItHCEA. 

solution of nitrate of silver. But the irritable 
state of the prostatic portion is more properly 
an effect rather than a cause of spermator- 
rhoea ; accordingly, we postpone the further con- 
sideration of it until we come to treat of the 
therapeutic measures proper to the malady it- 
self. 

Remedial Management. — Remedies should be 
employed with reference to the pathological 
states of the several phases of spermatorrhoea. 

In the genital form there are associated with 
the peripheral irritation increased reflex excita- 
bility and derangement of the primary assimi- 
lation. There may be a condition of plethora, 
or more or less emaciation ; much more usually 
the latter : the therapeutical methods are indi- 
cated in this brief pathological summary. In 
those rather exceptional cases, in which the 
spermatorrhoea is the result of plethora and 
forced continence, it may only be necessary to 
impart to the patient correct views of the im- 
portance of the losses, which, influenced by cur- 
rent publications, he will be very apt to exag- 
gerate. If his vessels are full, his bowels are 
constipated, and his digestion active, he will be 



TREATMENT. Ill 

benefited, if somewhat reduced by saline cathar- 
tics, by liquor potassce, by a less liberal diet, by 
abundant exercise, and b} T diminishing the num- 
ber of hours devoted to sleep. Many cases of 
so-called idiopathic spermatorrhoea occur in 
studious persons of sedentary habits, whose 
nervous system has been rendered unduly ex- 
citable by prolonged mental work with enfeebled 
digestive powers. These are relieved by mental 
rest, by* some physical employment, and by at- 
tention to the state of the digestive organs. 

Activity of the sexual system may be asso- 
ciated with this excitable state of the nervous 
system in studious persons ; when, of course, 
the anaphrodisiac remedies will be required. 
It has happened to me to meet cases of this 
character in clergymen who led a life of celibacy. 
A judicious employment of the hygienic means 
together with the medical, and especially a can- 
did statement of the real importance of the in- 
firmity, will be followed by most satisfactory 
results. 

A vast majority of the patients who pre- 
sent themselves for treatment do not belong to 
either of the foregoing classes. They are those 



112 SPERMATORRHOEA. 

in whom seminal weakness has been induced 
by masturbation, or by prolonged excesses in 
venery. They have frequent nocturnal emis- 
sions. The reflex excitability of the cord is so 
much increased, that the feeblest irritation pro- 
cures a prompt emission with little of venereal 
orgasm, and the frequent discharges of nervous 
force affect the supply to all the organs — whence 
come palpitation, indigestion, constipation, irri- 
table bladder, pain in the back, mental feeble- 
ness, and debility. The peripheral irritation and 
the reflex excitability must be diminished. These 
important objects may be accomplished by 
means partly hygienical and partly medicinal. 

The patient should cease his excesses, what- 
ever they may have been, and avoid all sources 
of excitement, whether the reading improper 
publications, suggestive novels or works upon 
his own malady, or the society of women of 
easy virtue. The liberties between the sexes 
permitted by custom in many places and in 
certain circles of society without extending so far 
as the gratification of desire, are so very iojuri- 
ousto young men with " seminal weakness," that 
they should be absolutely interdicted. The 



TREATMENT. 113 

inind of tlie patient should be freed, as far as 
possible, from any association with his disagree- 
able infirmity. Hence constant and agreeable 
employment, physical rather than mental, or an 
association of the two, is especially desirable. 
The bromide of potassium will powerfully con- 
tribute to the success of these measures. Forty 
to sixty grains may be given every night until 
sexual desire is entirely suspended. This reme- 
dy has a decided power to allay urethral irrita- 
tion, as we have found, not only in the cases for 
which it is now recommended, but in gonor- 
rhoea after the acute stage has subsided, and in 
gleet. We observe that Mr. Hutchison* has 
committed himself to the same opinion. In 
that very distressing complication of sperma- 
torrhoea — hyperesthesia of the spermatic plexus 
— the bromide of potassium is, also, very effec- 
tive. If decided anaamia exist in these cases of 
the genital form, iron and quinia may be given 
during the day, conjoined with lupulin, should 
it be desirable to increase the anaphrodisia. 
"We have seen that dilatation of the inter- 

* London Hospital Reports, vol. ii., p. 340. 



114 SPERMATORRHOEA. 

rachidian vessels probably exists in advanced 
cases. This view seems confirmed by the fact 
that the involuntary emissions occur much more 
certainly when the patient is lying on his back 
— a position favoring congestion of the cord. 
Hence management of the position in bed is not 
to be neglected. The patient should lie upon 
his side, and if unable to continue in this posi- 
tion when asleep, should adopt some mechani- 
cal appliances to compel it. Tying the hand 
to the bed-post so that the position of the back 
cannot readily be assumed may suffice in some 
instances. Or, Lallemand's contrivance may 
be adopted : this consists of a thin sheet of lead 
to which a piece of wood is fastened, attached 
by a girdle to the loins. Or, Mr. Acton's expe- 
dient, which is nothing more than a towel tied 
about the waist with a large knot behind. Or, 
lastly, the leather ring armed with metallic 
points, which will arouse the patient when 
erection occurs. 

The principal remedial agent for inducing 
contraction of the inter-rachiclian vessels is 
ergot. The drug should be fresh, or carefully 
prepared ergotin or fluid extract should be 



TREATMENT. 115 

used. Gelsemimn may be used for the same 
purpose. It is probably more effective even 
thau ergot. Cold to the spiue, not too pro- 
longed, or alternate hot and cold douches, may 
be usefully conjoined with the ergot. It should 
be remembered, however, that cold to the spine 
is a powerful aphrodisiac. 

If the patient experience the tenacious dis- 
charge from the urethra, consisting of the se- 
cretion from the prostate, Cowper's glands, and 
follicles of the mucous membrane, he will un- 
doubtedly believe himself to have ' ; diurnal pol- 
lutions," and will be correspondingly alarmed. 
If the discharge do not cease during the course 
of treatment just recommended, it will be ne- 
cessary to adopt some special means to ar- 
rest it. These special means consist in the 
local application in the manner already indi- 
cated of tanno-glycerine, of solutions of nitrate 
of silver, or the use of the povte caustique. "We 
should not forget, however, that caustic appli- 
cations are considered by Henry Thompson* 
as a cause of prostatitis. 

* On Enlarged Prostate : Its Pathology and Treatment, 
Loudon, 1858, p. 195, op. cit. 



116 SPERMATORRHEA. 

Our duty is not ended in a case of sperma- 
torrhoea, with the production of a state of ana- 
phrodisia and the curing of irritation in the 
urethra. We must restore the patient to the 
proper performance of his sexual functions, 
and this must be accomplished in such a way 
that he will not lapse into his former infirmity. 
The bromide of potassium and the ergot must 
be suspended, and tonics and special excitants 
must be employed. Extract of nux vomica or 
strychnia with iron, is a useful combination 
under these circumstances. Cimicifuga and 
gelsemium are also indicated, if there be any 
decided nervous phenomena present as a com- 
plication. Galvanism should not be neglected. 
In these cases, Duchenne's method should be 
practised : i. e., one rheophore in the rectum ; 
the other passed into the prostatic part of the 
urethra. Benedikt reports great success by his 
mode of applying the currents. Sometimes 
static electricity is of great service. The pa- 
tient is placed on an insulated stool, in commu- 
nication with the prime conductor, and sparks 
are drawn from the genitals. 

During the whole period occupied by this 



TREATMENT. 117 

treatment certain accessories must not be dis- 
regarded. Simple but nutritious food must be 
taken; the supper should be light, and eaten 
four or five hours before retiring, and alcoholic 
stimulants should be avoided. The habitual use 
of tea, coffee, and tobacco should be discour- 
aged. Fluids and articles of food having a 
diuretic action should be sparingly used, since 
erections occur when the bladder becomes full. 
Laxatives are indicated if constipation exist, 
but not otherwise. 

In that phase of spermatorrhoea which we 
have denominated the cerebral, in addition to 
the derangement of the sexual-spinal system 
there exists some form of cerebral disorder. If 
the sexual troubles are mere symptoms of mental 
derangement, the treatment of them is merged 
into that for insanity. If, on the other hand, 
the mental derangement is the result of seminal 
losses or abuse, the treatment of it becomes as- 
sociated necessarily with that for the cause. 
The cases given in the extract from Dr. Wil- 
liams's pamphlet belong to the first class ; the 
typical cases presented under the head of the 
cerebral form are instances of the second. The 



118 SPERMATORRHEA. 

first are not amenable to the action of anaphro- 
disiacs, whilst the second are. Usually the 
mental derangement has proceeded no further 
than hypochondria, melancholia, or trembling 
delirium (delusional insanity) corresponding to 
delirium tremens of alcoholismus. In all of the 
psychical affections of spermatorrhoea the bro- 
mide of potassium is very efficacious. Ergot 
should be administered in conjunction with it, 
and counter-irritants (firing, setons, blisters,) 
should be applied to the nape of the neck, on 
Schroeder van der Kolk's plan, and also as 
recommended by Romberg. 

The early recognition of mental disorders 
arising from abuse is very important. With the 
anaphrodisiacs — bromide of potassium, lupulin, 
and camphor — and moral agencies, should be 
conjoined the operation of circumcision. Physi- 
cal constraint may also be resorted to, but this 
is a temporary expedient which more usually 
fails than succeeds. Division of the vasa de- 
fer entia in inveterate cases has been recom- 
mended, and we have seen it performed in an 
inveterate case. Nothing but a failure in the 
means already proposed will justify the perform- 



TREATMENT. 119 

ance of this operation, as in its practical re- 
sults it is equivalent to castration. The opera- 
tion is readily enough performed. The duct 
can be easily felt and separated from the rest 
of the spermatic cord, when it may be divided 
by the subcutaneous section. 

In the spinal form of spermatorrhoea the 
treatment will be influenced by the condition of 
the cord. If the loss of power, the altered and 
referred sensations, the paraplegia, be merely 
functional derangements, or due to a " dynamic 
alteration," strychnia, cimicifuga, faradization, 
douches, hot and cold, to the spinal column, 
will be indicated. Bromide of potassium is 
hurtful in the paraplegia of sexual excess. It 
is, however, especially applicable to the treat- 
ment of the epilepsy and chorea of spermator- 
rhoea. The striking results obtained by Mr. 
Heckford, and my own observations, warrant 
me in strongly urging the operation of circum- 
cision, in those convulsive disorders due to 
masturbation. In the typical cases of the spinal 
form narrated under that head, I found the ex- 
tract of belladonna of signal advantage. 

Treatment of Impotence. — The temporary im- 
9 



120 SPERMATORRHOEA. 

potence of spermatorrhoea requires time and 
familiarity with the object of desire. If it con- 
sist of nothing more than such a degree of ex- 
citability of the reflex faculty, that intromission 
cannot be accomplished, or that the seminal 
discharge takes place after very imperfect coi- 
tus, then the treatment recommended for the 
genital form of spermatorrhoea may be pur- 
sued. 

In the impotence dependent upon spermator- 
rhoea of long standing, hot and cold douches to 
the spine, galvanism or static electricity, and a 
properly conducted system of physical training 
and exercise, are the most appropriate measures. 
Special excitants may be employed in conjunc- 
tion with these means : strychnia, phosphide of 
zinc, cannabis indica, cantharides, etc. ; but 
these remedies will not be successful unless the 
general health has been restored by proper hy- 
giene and suitable haematinics. "When the im- 
potence depends upon " irritable testis," a judi- 
cious course of bromide of potassium should 
precede the use of the other measures. Some 
of these cases may be very quickly cured by an 
induction current passed through an insulated 



TREATMENT. 121 

metallic sound introduced into the bladder. 
The occasional passage of a full-sized catheter, 
I have found in not a few instances, to produce 
energetic erections. 

The question of the propriety of marriage 
often involves considerations of great delicacy. 
Many cases are undoubtedly curable in this 
way. Marriage will always have a fortunate 
result in the cases of spermatorrhoea of physio- 
logical origin. In true spermatorrhoea, marriage 
may be enjoined when the genital apparatus is 
not so impaired in function as to prevent intro- 
mission. Regular intercourse, not too frequent- 
ly repeated, will prove of signal advantage in 
these cases. At first sexual contact may be un- 
satisfactory in consequence of the greatly in- 
creased reflex excitability of the ejaculatory 
apparatus ; but power increases by judicious 
use of the organs. 

Singular as the opinion may appear, I cannot 
refrain from stating that marriage has resulted 
unhappily more frequently in cases of imagi- 
nary spermatorrhoea than in the other forms 
described. When the supposed existence of 
this trouble becomes a predominant idea, and 



122 SPERMATORRHEA. 

moral and medicinal treatment cannot destroy 
or weaken it, marriage will only confirm the 
delusion, for the first attempts proving failures, 
the patient will give himself up to the most ab- 
solute conviction of incompetence. 



FORMULA. 123 



FOBMULM 

INJECTIONS. 

Argenti Nitrat., gr. x. 
Aquae Distil., 5 j. 
Solve. 

3. 

Zinc. Sulphat., gr. xij. 
Morphiae Sulphat., gr. iv. 
Atropiae Sulphat., gr. ss. 
Aquae Distil., § j. 
M. 



Acidi Tannici, 3 j. 
Glycerini, f j. 
M. 

#.; 

Acid. Tannici, 3 j. 
Tinct. Iodinii, 3 ss. 
Glycerini, I j. 
M. 



124 SPERMATORRHEA. 

Bismuthi Subnitrat., 3 ij. 
Ext. Hydrastis FL, 3 j. 
Mucil. Acacise, 3 vij. 
AquaB, ij. 
M. 

Ext. Hydrastis EL, gj. 
S. 10 drops injected through, the 
urethral tube into the pros- 
tatic part. 

Anaphrodisiacs. 

Lupulin., gr. vj. 
Pulv. Camphorse, gr. iij. 
Ext. Belladonna, gr. j. 
ft. pil. no. vi. 
S. One 3 times a day. 

Atropise Sulphat., gr. ss. 

Aquae Distil., § ss. 
M. 
S. 3 to 5 drops 3 times a day. 



FORMULA. 125 

9- . 

Tinct. Gelseroii, 3 j. 

Tinct. Belladonnas, 3 ij. 
M. 
S. 15 drops 3 times a day. 

Tinct. Gelsemii, 3j. 

Tinct. Cimicifugae, 3 vij. 
M. 

S. 30 drops to a teaspoonful 3 times 
a day. 

9. 

Potassii Bromidi, § j. 
ft. pulv. no. viii. 
S. One dissolved in water every 
night. 

9- 

Potassii Bromidi, 1 j. 

Ext. GelsemiiFL, 3ij. 

Syrp. Simpl. 3 vj. 

Aquae Cinnamomi, § iij. 
M. 
S. A teaspoonful 3 times a day. 



126 SPERMATORRH(EA. 

Potassii Bromidi, I j. 

Ext. Belladonnae, Fl. 

Ext. Gelsemii Fl., aa 3 ij. 

Syrp. Simpl., I iss. 

Aquae Menth. P., £ ij. 
M. 
S. A teaspoonful 3 times a day. 

Aphrodisiacs. 

Tinct. Cantharidis, 3 j. 

Tinct. Cannabis Ind. 

Sol. Morphias Bi-mec, aa 3 ij. 
M. 
S. 15 drops 3 times a day. 

Pilocarpin. Muriai, gr. iij. 

Aquae Distil., | j. 
M. 
S. 10 to 20 minims twice a day. 

Zinci Pkosphidi, gr. iij. 
Conserv. Rosae, 3 ss. 
ft. pil. no. xxx. 
S. One night and morning. 



FORMULAE. 127 

Tinct. Nucis Vom., 3 j. 

Tinct. Actese Baa, 3 iij. 
M. 
S. 20 drops 3 times a day. 

Syrp. Ferri, Quiniae, et Strychnia? 
Phos., I ij. 
S. A teaspoonful 3 times a day. 

Auri Terchloridi, gr. j. 
Ext. Nucis Yom., gr. v. 
ft. pil. no. xx. 
S. One 3 times a day. 

Ext. Jaborandi EL, I ij. 
S. Half a teaspoonful twice a day. 

Urethral Suppositories . 

Iodoformi, 

Acid. Tannici, aa gr. vj. 
01. Theobrom., q. s., 
ft, supposit. ureth. no. vi. 



128 SPEEMATOEEHCEA. 

Acid. Tannici, gr. vj. 
Ex. Belladonnas, gr. j. 
01. Theobroni., q. s. 

ft. supposit. ureth. no. vi. 

Plumb i Acetat., gr. xij. 
Morphias Acetat., gr. j. 
01. Theobrom., q. s. 

ft. supposit. ureth. no. vi. 



?• 



Morphias Sulph., gr. iij. 
Zinci Sulph., gr. yj. 
01. Theobroni., q. s. 

ft. supposit. ureth. no. yi. 



THE END. 




LIBRARY OF CONGRESS 



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